Oncology & Hematology Coding Alert

Question: How would a radiation oncologist code for a Fletcher-Suit ovoid radiation device inserted vaginally for radiation treatment for cervical cancer? Would 57155 and 77761 be correct?

Missouri Subscriber

Answer: Code 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy) is correct -- as long as the radiation oncologist performed the insertion. The physician who performed the insertion is the one who can charge 57155, so if a gynecologist or gynecologic oncologist inserted the Fletcher-Suit device, he's the one who should report the code.

Depending on the type of radiation delivery, for the brachytherapy application you-ll report either:

• 77761-77763 (Intracavitary radiation source application ...) for intracavitary or low-dose rate (LDR) therapy, or
• 77781-77784 (Remote afterloading high-intensity brachytherapy ...) for high-dose rate (HDR) therapy.

Remember: You also have associated codes for planning and related services that take place prior to and post-implant, such as 77263 (Therapeutic radiology treatment planning; complex) and 77290 (Therapeutic radiology simulation-aided field setting; complex). However, you should not report 77427 (Radiation treatment management, five treatments) -- that code is only appropriate for external beam therapy radiation management.

Don't miss: If the radiation oncologist performs both the insertion of the ovoids and administers brachytherapy, you must have separate documentation of each service. While this does not require two pieces of paper, there must at least be separate paragraphs for the surgical insertion of the applicator(s) and the brachytherapy administration.

Note: For more information on intracavitary brachytherapy, see -Unravel the Secret of Accurate Intracavitary Brachytherapy Coding- in Oncology Coding Alert, Vol. 9, No. 11.