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Laparoscopic radical prostatectomy is a minimally invasive surgical procedure developed as an alternative to conventional, open radical retropubic or perineal prostatectomy as a definitive treatment for patients with localized prostate cancer.
Since the introduction of prostate-specific antigen (PSA) testing in the 1980s, the number of radical prostatectomies performed in the United States has increased dramatically. However, radical prostatectomy is associated with substantial morbidity, with possible complications such as urinary incontinence, urethral stricture, and impotence, as well as the morbidity associated with general anesthesia and a major surgical procedure. Consequently, advances in minimally invasive and noninvasive therapy have been applied to the treatment of localized prostate cancer. Laparoscopic radical prostatectomy was first performed in 1991 by Schuessler and colleagues, who published a report on their initial series of nine cases in 1997. Since that time, radical retropubic prostatectomy using a laparoscopic approach has been performed at a few urologic centers in the United States, France, and Germany. Comparedwith conventional open surgery, the laparoscopic approach is designed to reduce abdominal wall morbidity since intra-abdominal access is obtained through several small ports rather than one large incision. The most commonly used laparoscopic technique involves a transperitoneal approach, which allows a larger operative space than an extraperitoneal approach, facilitating exposure and manipulation of instruments, and providing direct access to the seminal vesicles after incision of the posterior vesical peritoneum. The steps of the laparoscopic procedure are similar to those of standard retropubic prostatectomy with the exception that the dissection begins posteriorly with the seminal vesicles.
POLICYLaparoscopic radical prostatectomy is considered medically necessary.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY8/2002: Approved by Medical Policy Advisory Committee (MPAC) as investigational
5/21/2003: Code Reference section completed, CPT code 55866 added
11/5/2003: Code Reference section updated, ICD-9 diagnosis code 185, 198.82, 233.4 added
7/21/2005: Reviewed by MPAC, changed from investigational to medically necessary, Code Reference section non-covered codes table changed to covered codes table
1/22/2007: Policy reviewed, no changes
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.