Oncology & Hematology Coding Alert

Question: I've been coding A4648 with 55876, but CMS Transmittal 604, CR 6579, has me worried that I've been coding incorrectly. Should I report the two codestogether?

North Carolina Subscriber

Answer: You should report the codes together to Medicare if you're coding for the physician who performs the 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, prostate, single or multiple) service and your practice bears the cost of the device described by A4648 (Tissue marker, implantable, any type, each).

The goal of Transmittal 604, CR 6579 (www.cms.hhs.gov/Transmittals/downloads/R604OTN.pdf) was to clarify that physicians may report the codes together and expect payment for both. Different rules apply for hospitals and ambulatory surgical centers (ASCs), so they don't receive separate payment for A4648.

Medicare states if you, coding for the physician, report A4648, but don't report 55876 for the same date of service, you won't be paid for A4648. Take extra precautions not to report the marker kit on a Medicare Part B claim if your radiation oncologist simply provides the marker kit to another physician, such as a urologist.

Resource: In addition to the transmittal, Medicare has released an MLN Matters article on the topic: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6579.pdf.