Oncology & Hematology Coding Alert

Question: How do we report for a gold seed marker placement for future Cyberknife surgery? Also, please suggest how to select the most appropriate diagnosis codes.

Alaska Subscriber

Answer: For placement of gold seed markers, you report code 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple). You report code 55876 only once irrespective of the number of devices used during a single surgical session.

What are fiducial markers? Fiducial markers are pure gold seeds that are implanted in or around the point of surgery which help in identifying the exact target point of radiation therapy.

What is a dosimeter? A dosimeter is an instrument, which measures exposure to ionizing radiation.

Remember! You can also report any imaging guidance that was used. For example, you may report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) or 76872 (Ultrasound, transrectal) depending upon how and for what the imaging guidance was used.

Also: Check with your payer and bill A4648 (Tissue marker, implantable, any type, each) when your practice bears the cost of supplying the tissue marker.

Diagnosis codes: Report appropriate diagnosis codes depending upon the underlying condition for which the implanted the seed markers were placed. If a malignancy exists, the appropriate malignancy code for the primary or secondary lesion, based upon your oncologist’s documentation of the cancer is reported. If documentation indicates the malignancy no longer exists, the history or V codes are used.

Typically, gold seeds are implanted to provide treatment for a current or existing cancerous condition. Therefore, the most likely diagnosis would be a malignancy ICD-9-CM code.

For example, documentation may indicate malignancy of the prostate or related sites. Codes common for this procedure can be 185 (Malignant neoplasm of prostate), 198.82 (Secondary malignant neoplasm of genital organs), 233.4 (Carcinoma in situ of prostate), 236.5 (Neoplasm of uncertain behavior of prostate), or 239.5 (Neoplasm of unspecified nature of other genitourinary organs).