Oncology & Hematology Coding Alert

Take in this expert tip before you add 55875 to another oncology claim
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. Stay Alert to 76873 Options 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. Denial Alert: Watch 55875 Documentation 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 [...]