Oncology & Hematology Coding Alert

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.