Ob-Gyn Coding Alert

Use this modifier when radiologists report the same code Tackling uterine tandem coding can be challenging -- especially when your ob-gyn works with a radiologist to perform these services. Differentiate the two codes you-ll use and what modifier to append, and you-ll take charge of these tricky claims. Identify Key Terminology Ob-gyns perform brachytherapy, which is the application of a radiation source to cancer tissue, for early- stage cervical cancer or endometrial cancer. For cervical cancer, an applicator called a tandem and ovoid delivers radiation. A tandem and ovoid applicator consists of a hollow metal tube (the tandem) that the physician inserts through the cervix into the endometrial cavity. The tandem is about 10 inches long and is as thin as a pencil. The ovoids are hollow metal capsules small enough to fit in the vagina, up against the cervix. The ovoids have tiny radiation shields in them to reduce the radiation doses to the bladder and rectum. The patient then undergoes radiation therapy through the tandem and ovoid applicator by the physician placing radioactive capsules inside the hollow portions of the applicator. For uterine cancer, ob-gyns place Heyman capsules instead (especially when the uterus is very large). Similar to the tandem and ovoid application, the ob-gyn places the Heyman capsules in the uterine cavity. They too are loaded with radioactive material. By placing the empty cylinders and capsules in advance of introducing the radioactive element, the ob-gyn limits exposure to unsafe radiation for surrounding tissue. The ob-gyn may also decide to first place a hollow plastic tube custom fitted to the uterine cavity. He inserts this sleeve through the cervical opening into the uterus and sutures it in place onto the cervix. The purpose of the sleeve is to keep the cervix open, which allows for more comfortable and reproducible placement of the uterine tandem or Heyman capsules. In other words, the ob-gyn may have inserted and removed the tandems or capsules several times over the course of the patient's treatment. "The procedure takes about 20-30 minutes of operating room time," says Chris Buttrick, CPC, coding and reimbursement specialist for Cleveland Clinic Foundation in Cleveland. Solve These Scenarios The codes you have at your disposal for these procedures are 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy) and 58346 (Insertion of Heyman capsules for clinical brachytherapy). Scenario 1: A 49-year-old patient with stage 2 B cervical cancer has completed her external beam radiation. The physician schedules her for tandem and ovoid placement for brachytherapy to complete her radiation therapy. The patient gets into the lithotomy position. She is prepped and draped. The physician dilates the cervix using Hegar dilators and sounds the uterus. The physician inserts [...]