Oncology & Hematology Coding Alert

Question: What are the proper codes for a patient with ductal carcinoma in situ who receives HDR brachytherapy twice daily (MammoSite)? She had a single balloon catheter inserted after a lumpectomy, and it's one source, one channel. I need the codes for just the treatment.

New York Subscriber

Answer: The correct CPT code for the breast brachytherapy you describe is 77785 (Remote afterloading high dose rate radionuclide brachytherapy; 1 channel). Note that this code was added in 2009. For 2008 services, you instead reported now-deleted code 77781 (Remote afterloading high intensity brachytherapy; 1-4 source positions or catheters).

You may report 77785 for each treatment, so if the patient has treatment twice daily for five days, you would report the following to a typical payer for each date of service:

• 77785

• 77785-76 (Repeat procedure by same physician).

By appending modifier 76 to the second service, you tell the payer that each treatment was separate.

Tip: Payers may vary in their preferences for reporting the same service twice on the same date, so be sure to follow your payers' specific rules.

ICD-9: Ductal carcinoma in situ (DCIS) is noninvasive but can become invasive if untreated. DCIS involves abnormal cells growing within a breast milk duct. The appropriate ICD-9 code is 233.0 (Carcinoma in situ of breast and genitourinary system; breast).