Oncology & Hematology Coding Alert

The radiation oncologist's role in placing needles, catheters and seeds for prostate brachytherapy is growing, and your coding skills have to keep pace. Here's the skinny on the codes you need to know and the two codes most likely to land you in hot water: 55875 and 55876.

Keep in mind: Often the radiation oncologist will work with a urologist to treat a prostate brachytherapy patient. Result: You need to pay extra attention to which physician performed which procedure so that you code only those services your oncologist provides.

Before the physician can implant the radioactive seeds, the radiation oncologist or urologist must determine the size of the patient's prostate, says Sandy McMaster, ROCC, oncology financial performance coordinator with Edward Cancer Center in Naperville, Ill.

Typically this means a transrectal ultrasound using very specialized ultrasonic radiological equipment. The radiation oncologist usually performs these measurements using hospital equipment.

If you have documentation that the radiation oncologist performed the transrectal ultrasound to determine prostate size, report 76873 (Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]).

Remember: If the oncologist performs the service in the hospital outpatient department, append modifier 26 (Professional component) to reflect that the oncologist did not bear the cost for 76873's technical component, says oncology coding expert Cindy Parman, CPC, CPC-H, RCC, co-founder of Coding Strategies Inc. in Powder Springs, Ga. You need to have a documented interpretation and report by the physician who performs the service to report the professional component, Parman adds.

Don't miss: The phrase "separate procedure" in 76873 means that payers typically bundle the procedure into anything else done that day, Parman says. For example, Correct Coding Initiative (CCI) edits bundle 76873 into brachytherapy code 77778 (Interstitial radiation source application; complex). Good news: Patients typically have the ultrasound on a separate day, before treatment, Parman says.

Traditionally, the urologist has been responsible for placing the needles used to implant the brachytherapy seeds. CPT 2007 changed the number (but not the descriptor) for this service from 55859 to 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy), says Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York in Stony Brook.

Red flag: Pay special attention to the fact that 55875's descriptor says "with or without cystoscopy," which allows the physician to determine the seeds- location and whether any have been misplaced (such as in the bladder).

If your radiation oncologist pairs with a urologist for a prostate brachytherapy procedure, the physician who places the needles or catheters into the prostate and typically performs the cystoscopy should report 55875. If both physicians report the code, the payer will deny one of the claims.

The reason CPT 2007 changed the code number for needle placement with or without cystoscopy is that as 55859, the service sat in the "Excision" subheading of CPT's prostate subsection, leading coders to erroneously assume this is an excisional procedure, according to the AMA's CPT Assistant May 2007 article "Radiation Therapy Treatment of Prostate." As 55875, CPT more accurately lists the code under "Other Procedures."

When the radiation oncologist places the seeds using intracavitary radiation source application, you should typically report 77778.

Imaging note: Either the radiation oncologist or the urologist provides the ultrasonic guidance (76965, Ultrasonic guidance for interstitial radioelement application) for placing the seeds, but you-ll usually see the urologist perform this, when he's present, Parman says.

Fight the temptation to report 55876 (Placement of interstitial device[s] for radiation therapy guidance

[fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple) for brachytherapy claims.

Reserve 55876 for when the physician implants metallic marker seeds (also called fiducial markers) -- not brachytherapy seeds -- in the prostate, according to the May 2007 CPT Assistant.

The marker seeds, or fiducial markers, help localize glands, organs and tumors during external beam radiation therapy. Before CPT 2007 introduced 55876, you had to report this service with 55899 (Unlisted procedure, male genital system).

Bottom line: Code only those services the physician you-re coding for performed.