Example A — Primary whole-gland cryoablation
Clinical: Localized disease in a non-surgical candidate; whole-gland cryoablation under ultrasound guidance.
Code(s): 55873.
Dx: C61.

Example B — Focal HIFU of an MRI-visible lesion
Clinical: Intermediate-risk unilateral disease; focal HIFU of the index lesion after coverage verification and prior authorization.
Code(s): 55880.
Dx: C61.

Example C — Salvage cryoablation after radiation failure
Clinical: Biopsy-proven local recurrence three years after EBRT; negative metastatic workup; salvage cryoablation.
Code(s): 55873, with the radiation history and recurrence workup documented to the payer's salvage criteria.
Dx: C61; R97.21 as supporting dx when documented.

• Coverage verification: payer policy for the exact indication, in writing, in the chart
• Prior authorization: obtained where required
• Selection rationale: risk category, lesion localization, and why ablation over surgery/radiation/surveillance

• Treatment field: whole-gland vs focal, with the imaging/biopsy findings that define it
• Guidance and monitoring: modality documented (included in the code)
• Salvage detail: prior radiation course and recurrence workup when applicable

• Investigational determinations: verify the payer's position on the specific indication before scheduling — this is the dominant denial in the category.
• Missing prior auth: build the auth check into scheduling for every ablation case.
• Guidance unbundling: do not bill ultrasound guidance separately with 55873/55880.
• Salvage without the story: radiation history and recurrence workup must be in the record submitted.

• 55873 – Cryosurgical ablation of the prostate (includes ultrasound guidance and monitoring)
• 55880 – Ablation of malignant prostate tissue, transrectal, with high-intensity focused ultrasound (HIFU), including ultrasound guidance

• 53899 – Unlisted procedure, urinary system — per payer guidance for technologies such as focal laser ablation or IRE [VERIFY: technology-specific coding]

• C61 – Malignant neoplasm of prostate (primary on the ablation claim)
• R97.21 – Rising PSA following treatment (salvage workup, supporting dx)
• Z19.1 / Z19.2 – hormone sensitivity status when documented

• Indication: risk category, lesion localization, and treatment-selection rationale
• Coverage evidence: the verified payer policy and authorization in the chart
• Treatment field: whole-gland vs focal, described against the imaging
• Salvage cases: prior radiation, biopsy-proven recurrence, negative metastatic workup
• Follow-up plan: post-ablation surveillance schedule

• -78 / -79 / -58 for global-period returns; repeat/staged focal treatments need clear staging documentation
• -22 only with documented substantially greater work

• 55873 and 55880: 90-day global.
• Confirm using your MAC/payer fee schedule.

• MAC LCDs/articles govern much of this space; commercial payers vary more — keep a payer-by-payer coverage grid current [VERIFY: current policies].

• Facility charge capture: 55873 (cryo) and 55880 (HIFU) with probe/disposable capture per charge policy.
• Status indicators: confirm OPPS/ASC status and APC assignment for both codes in your setting [VERIFY: SI/APC].
• Coverage alignment: the facility should hold the same coverage verification/authorization evidence as the professional side.

• C61 – primary on the ablation claim
• R97.21 – supporting dx on salvage episodes when documented

Facility tip: align diagnosis coding with the professional claim; investigational-service denials frequently hit the facility claim first.

• Authorization file: coverage verification and prior auth attached before the case
• Op note detail: treatment field, guidance, and device/probe documentation
• Supply log: probes and disposables matching the charges
• Record alignment: op note, nursing record, supply log, and charge capture must tell the same story

• Packaging rules vary: probes and disposables package differently in ASC vs HOPD.
• Site-of-service variance: confirm where each technology is payable before committing the case to a setting.
• New-technology posture: expect medical-record requests on early cases; assemble the coverage file at charge entry.