Oncology & Hematology Coding Alert

Question: If the radiation oncologist places fiducial markers into the prostate using ultrasound guidance, which codes should I use? We're a freestanding center and own the ultrasound equipment, so I'm not sure if I should use modifier 26.

Washington Subscriber

Answer: The proper code for placing fiducial markers is 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple). Code 55876 doesn't have professional and technical components, so you should not consider using modifier 26 for this code regardless of place of service.

Use 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the ultrasound guidance. Because your center owns the equipment, you do not need to append modifier 26 (Professional component) to 76942. You may report the global service.

55876 tip: Remember, 55876 reflects metallic marker seed (aka fiducial marker) implantation. These marker seeds are not the same as brachytherapy seeds. Instead, the markers help localize glands, organs, and tumors during external beam radiation therapy. This code also includes the implantation of "smart fiducials," which are dosimetricbeacons.