Oncology & Hematology Coding Alert

Question: Our hospital will begin to do HDR soon. What code should I report for a radiation oncologist when he is placing the needles and interstitial catheters in the OR? The urologist will be placing the cystoscope into the bladder through the penile urethra, and will collect an ultrasound study in conjunction with the radiation oncologist. Can I report 55875 for the radiation oncologist's work?

Pennsylvania Subscriber

Answer: There are several services performed in connection with prostate high-dose rate (HDR) therapy or prostate seed implants, and the documentation determines which physician can bill for the procedures:

HDR: The radiation oncologist should report a code from the 77781-77784 series (Remote afterloading high-intensity brachytherapy ...) for the actual HDR, depending on the number of source positions required for treatment.

Catheters: The physician who placed the catheters -- whether it was the urologist or the radiation oncologist -- should report 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy). This code does not accept cosurgery, team surgery or assistant surgery modifiers -- only one physician can report this code.

Guidance: Code 76965 (Ultrasonic guidance for interstitial radioelement application) is used for the ultrasonic guidance prostate seed implants. Some payers will accept 76950 (Ultrasonic guidance for placement of radiation therapy fields) for HDR catheter placement; other payers accept 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for catheter placement.

If the urologist only performed the ultrasonic guidance, he would report the 769xx code, and the radiation oncologist would report 55875.

Note: For more information on brachytherapy coding, see "Master Prostate Brachytherapy Coding and Escape the Seed-vs.-Marker Trap" in Vol. 9, No. 9 of Oncology Coding Alert.