Radiology Coding Alert

Question: One of our radiation oncologists performed brachytherapy on a breast using a Mammosite device in the morning, and another radiation oncologist performed the procedure again on the same patient that afternoon. We plan to report 77784 but don't know which modifier to use. What should we do?

North Carolina Subscriber

Answer: When your Mammosite device uses a single dwell source, you should report 77781 (Remote afterloading high-intensity brachytherapy; 1-4 source positions or catheters) instead of 77784 (... over 12 source positions or catheters). In addition, you should append modifier -77 (Repeat procedure by another physician) to the second 77781 charge to indicate that each physician performed the same procedure, for a total of two separate procedures.
 
But if your radiation oncologist incorporated methods that use multiple catheters (such as a Kuske breast template), you should choose the appropriate code based on the number of catheters. For example, you would report 77782 (... 5-8 source positions or catheters) if you used five to eight dwell positions.