Radiology Coding Alert

Hint: A staged-procedure modifier may be your best bet

Pull the plug on HDR coding mistakes by studying this MammoSite example.
 
Example: A breast cancer patient returns for HDR treatment following insertion of a single balloon catheter by the oncologist when he excised her tumor. The oncologist treats the patient with HDR brachytherapy twice a day for five days. For the first day, report the following for the HDR treatment, Parman says:
 
• Treatment 1: 77781
 
• Treatment 2: 77781-58 (Staged or related procedure or service by the same physician during the postoperative period) -76 (Repeat procedure by same physician).

For days two through five, report the following:
 
• Treatment 1: 77781-58
 
• Treatment 2: 77781-58-76
 
Rationale: The patient has only one catheter, making 77781 the appropriate HDR code choice. You may report HDR for each treatment, and appending modifier 76 defines the separate nature of each treatment. Modifier 58 lets payers know the treatment is a preplanned follow-up service. Some payers may ask that you report two units of 77781 each day instead, so be sure to track your payers' preferences.
 
Note: While you may separately report a number of other radiology codes with HDR (such as 77263, Therapeutic radiology treatment planning; complex; and 77290, Therapeutic radiology simulation-aided field setting; complex), you should NOT report 77427 (Radiation treatment management, five treatments) with HDR.
 
ACR and ASTRO maintain that 77427 is only appropriate for external beam therapy radiation management, Parman says.
 
As always, individual payer guidelines take precedence, so follow your local policies, she says.