Oncology & Hematology Coding Alert

Question: One of our radiation oncologists performed a breast brachytherapy using a Mammosite device in the morning, and another radiation oncologist performed the procedure again on the same patient that afternoon. We plan to report 77784 (Remote afterloading high-intensity brachytherapy; over 12 source positions or catheters), but don't know which modifier to use. Can you help? 

North Carolina Subscriber

Answer: When your Mammosite device uses a single dwell source, you should report 77781 (...; 1-4 source positions or catheters) instead of 77784. Also, you should append modifier -77 (Repeat procedure by another physician) to 77781.
 
However, if your oncologist incorporated methods, such as Kuske breast template, that use multiple catheters, you should choose the appropriate code based on the number of catheters. For example, you would report 77782 (... 5-8 source positions or catheters) for using five to eight dwell sources.