Urology Coding Alert

Myth #1: Since a radiation oncologist calculates the dosimetry of radiation and places the radioactive seeds, you won't be able to report the urologist's involvement in the procedure.

Reality: If your urologist pairs with a radiation oncologist for a prostate brachytherapy procedure, the physician who places the needles or catheters into the prostate and typically performs the cystoscopy should report 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy), says Teresa A. Dailey, CPC, coding specialist for Urology Center of Spartanburg in South Carolina. If both physicians report this code, the payer will deny one of the claims. The AMA originally added the code for the urologist alone, and you should be using it only for the urologist, not the radiation oncologist.

Take note: CPT 2007 changed the number (but not the descriptor) for this service from 55859 to 55875.

Do this: For the ultrasonic guidance, report 76965-26 (Ultrasonic guidance for interstitial radioelement application; professional component), Dailey says. Appending modifier 26 indicates that the urologist performed only the professional component. Because this procedure is usually performed in a hospital, the facility will then bill for the technical component.

Bottom line: Code for the services your urologist performs during the procedure, but avoid reporting CPT codes for services that the other physician performs, such as 77778 (Interstitial radiation source application; complex).

Myth #2: When your urologist performs a cystoscopy after placing the seeds or brachytherapy needles, and the endoscopy is to evaluate a separate problem such as hematuria, rather than just to ensure correct seed position, you should separately report the cystoscopy.

Reality: "Unfortunately, 55875 represents the transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy," Dailey says. So despite a separate diagnosis, you cannot unbundle 55875 and 52000 (Cystourethroscopy [separate procedure]).

Red flag: Code 55875 includes several bundled column 2 codes under the Correct Coding Initiative (CCI), including specific urology catheterization codes 51701, 51702 and 51703 as well as cystoscopy codes 52000 and 52250. These urology code edits have a "0" modifier indicator, which means you can never override these CCI edits.

On the other hand, if the urologist obtains a plain film of the pelvis and abdomen, you can report 74000-26 (Radiological examination, abdomen; single anteroposterior view; professional component) with 55875.

Tip: Check with your individual payers to see if you can, and should, report cystoscopy and urethral catheterization codes separately. For example, Elaine Bloom, account coordinator for State College Urologic Associates in State College, Pa., says she reports 51702-51 (Insertion of temporary��'indwelling bladder catheter; simple [e.g., Foley]; multiple procedures) for private carriers, but Medicare will not pay for 51702 with 55875.

Myth #3: Only a radiation oncologist can report the volume study a patient undergoes before brachytherapy, so as a urology coder you can ignore coding this part of the overall procedure.

Reality: Although the radiation oncologist may also perform an additional volume study (76873, Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) during the prostate brachytherapy treatment planning, the urologist may elect to perform this test himself, if he has the equipment, one week or so prior to seed insertion or at the time of seed implantation. Keep in mind, however, that the radiation oncologist most often performs this study.

If a urologist does perform this study, urology coders sometimes overlook coding and billing 76873 because they're not used to reporting it. But if your physician does perform it, you should be coding for it. If performed in a hospital or the office, bill only for 76873's professional component by appending modifier 26 for the interpreting and applying the test results.

Warning: Only one physician can bill for the treatment plan. The physician who assists or watches during the procedure should not separately charge for his participation.

Remember: Every case is different, so coding may not be the same from office to office, or even from case to case. For example, Dailey never reports ultrasonic guidance using 76873 because a radiation oncologist, rather than her urologists, always performs the volume study before the surgery. On the other hand, Bloom says she codes 76873 with modifier 26 because her urologist performs this study during the implant surgery in the hospital. She adds modifier 26 because the hospital owns the equipment, and the urologist bills only for the study's interpretive portion.

Summary: Your composite coding for the prostate brachytherapy procedures, if your urologist performs them all, would be:

• 55875 for placing the needles or catheters
• 76965-26 for the ultrasonic guidance
• 51702-51 for the Foley catheter insertion; report this code only to private carriers
• 76873-26-59 for the volume study if your urologist performs the service at the same encounter; CCI bundles 76873 into 76965, so you need to use modifier 59 (Distinct procedural service) to break the edit
• 74000-26 for the x-ray film.