Ob-Gyn Coding Alert

Question: Our gynecologist placed a Smitt sleeve so the radiation oncologist could insert the radiation device. How should we code for this?

Minnesota Subscriber

Answer: If the ob-gyn only places the Smitt sleeve and does not place the tandem and ovoids at the same time, you should report 58999 (Unlisted procedure, female genital system [nonobstetrical]) because CPT does not contain a code that specifically represents this procedure. If the doctor inserts the sleeve at the same time as the tandem and ovoids, you can bill this as 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy) appended with modifier -22 (Unusual procedural services) to show the extra work involved.
 
To more easily apply these codes, you should have a good understanding of how the procedure works. Physicians generally deliver brachytherapy for early-stage cervical cancer using an applicator called a tandem and ovoids. Before the first treatment, the doctor may place a Smitt sleeve intraoperatively. The Smitt sleeve is a hollow plastic tube that is fitted to the length of the uterine cavity. The physician inserts it through the cervical opening into the uterus, and then sutures it into place on the cervix. This sleeve stays in the uterus for all the treatments.
 
The Smitt sleeve keeps the cervix open, allowing for comfortable and accurate positioning of the tandem. The tandem is a hollow metal tube that will temporarily hold the radioactive source, which the physician inserts into the Smitt sleeve. The doctor places the two ovoids on either side of the cervix at the top of the vagina. They also will hold the radioactive source during treatment. Tiny radiation shields in the ovoids reduce the radiation doses to the bladder and rectum.