Ob-Gyn Coding Alert

Question: The ob-gyn diagnoses a 68-year-old patient with uterine cancer. She is not a candidate for surgery because of her severe cardiac disease, so the ob-gyn decides to treat her cancer with radiation therapy, including clinical brachytherapy. They schedule the patient for Heyman capsule insertion.

The patient gets into the lithotomy position and is prepped and draped. The physician dilates the cervix using Hegar dilators and sounds the uterus. Because of the patient’s uterus size, the physician inserts six capsules. Long tubes connect the capsules to the outside of vaginal outlet. The radiation oncologist will apply the radioactive element through these tubes into the capsules at a later session.

How should I report this?

California Subscriber

Answer: Because this example describes the insertion of Heyman capsules, you’ll report 58346 (Insertion of Heyman capsules for clinical brachytherapy).

Keep in mind: A radiation oncologist will perform the supervision of the radioelements and dose interpretation, while another physician will insert the empty tandems, ovoids, or capsules. These latter tasks usually take place at a different session and require significant time and expertise. Therefore, you will usually not append modifier 62 (Two surgeons) — unless the radiation oncologist and ob-gyn perform these services during the same session. If that’s the case, according to the Medicare Carriers Manual (MCM), section 14046, each surgeon will receive 62.5 percent of the Medicare Physician Fee Schedule Database fee indicated for their service.