Pulmonology Coding Alert

Reader Question:

Check Insertion Method For Apt Reporting of Fiducial Markers

Question: Our pulmonologist recently diagnosed a patient with lung cancer. To enable radiation therapy, he planned the placement of fiducial markers. He placed 4 markers through bronchoscopy. When I checked the options for reporting fiducial markers I found that there are two options, namely, 31626 and 32553. Which of these two options should I report? Also, tell me if I need to report only one unit of the code or one unit for each of the markers placed?


Washington Subscriber

Answer: A fiducial marker is a marker that is placed to help as a reference point when radiation therapy is being planned and also to help in the precise delivery of radiation during therapy. You are correct in checking that there are two codes to report the placement of the fiducial markers. To report the appropriate CPT® code for the placement of the markers, you will have to check for the method that your pulmonologist used to place the markers.

If your pulmonologist placed the fiducial markers through a bronchoscope, you will have to choose 31626 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple) to report the procedure that he performed. However, if he placed the markers percutaneously through the chest wall, you will have to choose 32553 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-thoracic, single or multiple) to report the procedure correctly. Since your pulmonologist used bronchoscopy to perform the placement of the fiducial markers, you will have to choose 31626 and not 32553.

If you look at the descriptor to 31626 (or even 32553), it very clearly indicates that you will report this code for the placement of a single marker or multiple. So, even though he placed four such markers, you cannot report four units of 31626. Instead, you will have to report only one unit of 31626 irrespective of the number of markers that your pulmonologist placed through bronchoscopy.

Reminder: The CPT® code 31626 only covers the placement of the fiducial marker and doesn’t cover the supply of the marker. This will have to be reported separately using the HCPCS supply code A4648 (Tissue marker, implantable, any type, each). 

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