Oncology & Hematology Coding Alert

Radiation oncologists often use markers to be sure they're pinpointing the right anatomic area. And that means you have to be able to pinpoint the proper marker placement code.

Watch for: You have one more code to choose from with CPT 2010's introduction of 31626 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple). To be sure you're using the new code correctly, check out these "do" and "don't" tips straight from the AMA's CPT symposium.

Code 31626 may be appropriate when physicians place fiducial markers used to guide a thoracoscopy or to help visualize for a more precise lung wedge biopsy. Alternatively, the code may be appropriate when the physician places a marker to designate an area for radiation, said Scott Manaker, MD, PhD, physician at the University of Pennsylvania and AMA RUC American College of Chest Physicians (ACCP) representative, at the AMA's 2010 CPT and RVU symposium in Chicago.

Beware: Code 31626 is for one or more markers, Manaker stresses. Often, the physician places four; but a case could require five to six markers. "The code is still reported just once," Manaker said. But don't confuse placement with the markers themselves. If your practice bears the cost of the markers, you may report them separately (such as with A4648-A4650).

To keep 31626 straight from a second 2010-introduced fiducial marker placement code (32553, Placement of interstitial device [s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-thoracic, single or multiple), answer one simple question. "Ask, 'How did the marker get there?'" suggested Stephen Hoffman, MD, American Thoracic Society AMA CPT Specialty Advisor and Practice Management Committee chair at the 2010 symposium.

Solution: Look at which route the physician used to place the marker:

• Bronchoscopically: For a fiducial marker bronchoscopically delivered via the airway, report 31626.

• Percutaneously: "If the marker arrived there percutaneously through the chest wall, use 32553," said Hoffman, who is an associate professor of medicine for Ohio State University and Health System in Columbus.

Note: For information on other CPT 2010 fiducial marker placement changes, check out the chart below, and see "Add 2 More Options to Fiducial Marker Placement Coding" in Oncology & Hematology Coding Alert, Vol. 11, No. 14.