Urology Coding Alert

Because urologists often work with radiation oncologists to perform brachytherapy, the decision of who bills for what can confuse coders. The treatment has several components, adding to the coding challenge, so Urology coders must know the specific tasks the urologist performs to gain fair reimbursement.
 
Brachytherapy is a treatment in which radioactive seeds are implanted in the prostate to treat prostate cancer. Many patients prefer this treatment to radical surgery because it takes only one day and there is less chance of urinary incontinence or penile impotence. Reflecting this patient choice, more urologists are performing procedures associated with brachytherapy.
Use 76873 for Prostate Measurement  
Prior to seed placement, the radiation oncologist or the urologist determines the size of the prostate via transrectal ultrasound. This calculation is necessary for dosimetry -- calculating the right amount of radiation for the size of the prostate. If the urology practice has specialized sonographic equipment, often the urologist will perform the measurement. Use code 76873 (echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) for this sonographic evaluation.
 
Some urology coders may want to report 76872 (echography, transrectal) for the prostate-volume measurement, but this is inaccurate. Use 76872 when you sonographically view the prostate for stones and other lesions, not for the precise measurement of prostate size needed for dosimetry.  
Coding the Seed Implantation  
The urologist and the radiation oncologist perform the seed implantation together, each performing separate tasks. The procedure is done in the hospital or an ambulatory surgical center (ASC).
 
Coding for the procedure has several parts:
 
1. Needle placement. The urologist places the needles that will be used to implant the seeds. Report 55859 (transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) for transperineal placement of the needles. Only the urologist will use this code because it includes cystourethroscopy, which only the urologist can perform. The cystoscopy is necessary to check if any seeds have been misplaced into the urethral lumen or bladder lumen.
 
2. Ultrasonic guidance. The urologist should bill 76965 (ultrasonic guidance for interstitial radioelement application) for ultrasonic guidance for the needle placement. Append modifier -26 (professional component) to indicate that you are performing only the professional element. Because this procedure is performed in a hospital or ASC, the facility will bill for the technical component.
 
Urologists who fail to bill for ultrasonic guidance are missing out on $70 to $100, says Michael A. Ferragamo, MD, assistant clinical professor of urology at the State University of New York, Stony Brook.
 
3. Foley catheter placement. Medicare bundles 53670* (catheterization, urethra; simple) into 55859. Coders cannot bill separately for the catheter placement for a Medicare patient, but they can report 53670* for [...]