Ob-Gyn Coding Alert

MammoSite treats the breast without  6 weeks radiation Physicians placing balloon catheters for accelerated partial breast irradiation (APBI) now have CPT codes 19296 and 19297 to reflect their work.
 
Proxima Therapeutics' MammoSite radiation therapy system involves inserting a balloon catheter into the breast. APBI targets part of the breast after a lumpectomy over a five-to-six-day period instead of the weeks that older techniques require.
 
Many carriers, such as National Heritage in Northern and Southern California, have issued local coverage determinations (LCDs) for APBI that include brachytherapy codes (77326-77328), but until now there was no way to bill for the catheter placement. Two new codes cover the balloon catheter procedure:
  19296 - Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy
  +19297 - ... concurrent with partial mastectomy (list separately in addition to code for primary procedure).
 
Unless you code for a hospital, you may not be regularly reporting these codes. "Codes 19296 and 19297 are for the hospital and the surgeon placing that balloon in the OR for radiation therapy," says a radiation therapist from Cary, N.C. "These two codes came out because insurers weren't paying for the placement of the catheters and the balloon catheters themselves. Prior to this, we were paying for them."
 
What happens: The surgeon creates a tunnel or cubbyhole and inflates this balloon so that it can't be removed. "Two days later the patient comes to see us, and then we put radiation through that tube. We do that for five treatments, twice a day, six hours in-between," the radiation therapist says.
 
Codes 19296 and 19297 describe identical procedures, but you should take note of their difference. You should report 19297 when the physician performs the radiotherapy placement on the day of the mastectomy. List it with the mastectomy. However, you should report 19296 when the radiotherapy placement happens at a later date (and requires no primary procedure code to accompany it). Use 19298 for Older Tube-and-Button A third code, 19298 (Placement of radiotherapy afterloading brachytherapy catheters [multiple tube and button type] into the breast for interstitial radioelement application following [at the time of or subsequent to] partial mastectomy, includes imaging guidance), describes when the physician inserts the radiotherapy afterloading brachytherapy catheters of the older multiple tube-and-button type. "This is a different type of catheter; the entire needle is radioactive," the radiation therapist says.
 
Definition of tube-and-button: Brachytherapy (or low dose of radiation to a certain area) comes in long strands; they're like little seeds sewn into a strand of wire and have a little button so they don't fall off. These are then threaded through the skin where the [...]