Plan for Success: Master Prostate Brachytherapy Coding Now

Look to C codes to report technical services
As of Jan. 1, 2008, CMS allows ASCs to bill for technical services related to implanting radioactive seeds -- as well as the seeds themselves -- for treating prostate cancer. And the number of prostate brachytherapy services ASCs provide has already begun to increase. Get the facts now so you won’t be caught off guard when one of these claims lands on your desk.

Code the Procedure in 3 Parts

Prostate high-dose rate (HDR) brachytherapy consists of three billable parts -- catheter placement, seed placement, and technical services -- in an outpatient facility setting, and you should report each of these separately.
Note: Often, a radiation oncologist and urologist will work together to treat a prostate brachytherapy patient, but facility coders need not concern themselves about which physician performed which parts of the procedure.

Always Choose 55875 for Catheters

For catheter placement, you should call on 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy: APC 0163), says Teresa A. Dailey, CPC, coding specialist for Urology Center of Spartanburg in South Carolina. You may report only a single unit of 55875 per session, regardless of how many catheters the physician places.
Fight the temptation to report 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple) for brachytherapy claims. Rather, you should reserve 55876 for when the physician implants metallic marker seeds (also called fiducial markers) -- not brachytherapy seeds -- in the prostate, according to the May 2007 CPT Assistant.

Look to 77781-77784 for Seed Placement

For actual radioactive seen placement, you will report an appropriate code from the 77781-77784 series (Remote afterloading high-intensity brachytherapy ... : APC 0313), depending on the number of source positions required for treatment.
Example: If the patient requires six source positions, you would report 77782 (… 5-8 source positions or catheters) for placing the brachytherapy seeds. For 11 source positions, you would instead report 77783 (… 9-12 source positions or catheters).
Outpatient facility doesn’t report guidance: Often, the physician will use guidance to place the brachytherapy seeds (for example, 76965, Ultrasonic guidance for interstitial radioelement application). This service is not separately payable for facilities under the APC system.

Source Type, Version Matter for Technical Code

Finally, you should select from one of the new-for-2008 C codes to gain reimbursement for the cost of the brachytherapy source, as well as other technical services related to HDR [...]

- Published on 2008-04-09