Advanced Search

Oncology & Hematology Coding Alert

YOU BE THE CODER ~ Ask What ASC Can Claim for Brachytherapy

Published on Tue Nov 14, 2006

Question: I work for a surgery center that is performing its first prostate brachytherapy case next week. Can we bill for anything other than the facility fee?

Florida Subscriber

Answer: The answer depends on whether you are coding for the facility or the physician. If you code for the ASC facility, you will receive reimbursement only for 55859 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy). Remember to append SG (Ambulatory surgical center [ASC] facility service).

Note: Whether you-re reimbursed for the brachytherapy seeds will depend on your payer. For Medicare patients in Florida, check out page 34 of
www.floridamedicare.com/edu_local_manualsRadiation%20Oncology.pdf.

If you code for the physician, you can charge for the professional component of all services the physician performs with modifier 26 (Professional component) and POS 24 (Ambulatory surgical center).

Still, your payer may not separately reimburse all the services.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Oncology & Hematology Coding Alert

View All