Oncology & Hematology Coding Alert

Question: In treating patients with high dose radiation (HDR), the radiation oncologist and pulmonologist do a bronchoscopy and place the catheters for treatment. Both are involved in the procedure. What is the correct code for the radiation oncologist to charge, 31643 or 31725? Or is 31643 a pulmonology charge only?

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Answer: The appropriate CPT code to use is 31643 (bronchoscopy with placement of catheter[s] for intracavitary radioelement application). According to CPT 2000, when a procedure requires the service of a surgeon(s), in addition, either modifier -66 (surgical team) or -62 (two surgeons) may be used. The correct placement of the catheters is complex and often requires the pulmonologist to perform the bronchoscopy and the radiation oncologist to guide the location for placement of the catheters. In this situation, the work requires two physicians, and each physician should add modifier -62 or -66 to the appropriate code. Modifier -62 indicates there were two surgeons, each performing a separate task for this one procedure, while -66 shows that the process is complex and requires involvement of other team members such as dosimetrist, physicist, and specialized pulmonology staff.

After the catheters are placed, the patient is taken to the radiation oncology suite, and HDR remote afterloading is performed. The appropriate code, 77781-77784 (remote afterloading high-intensity brachytherapy) should be used and is dependent on the number of catheters loaded. Additional codes for HDR include the simulation and planning procedures.

This question was answered by Margaret Hickey, RN, MSN, MS, OCN, an independent coding consultant and former clinical director of the Tulane Cancer Center in New Orleans.