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Urology Coding Alert

Differentiate Urologist's Tasks for Proper Brachytherapy Coding

Published on Sat Jul 01, 2006

Don't forget to report ultrasound guidance when your urologist performs it in-office

When your urologist works with a radiation oncologist to perform brachytherapy for a patient, your challenge is knowing which codes you can report for the urologist's services and which ones the oncologist reports. Knowing the multiple components of brachytherapy can help you quickly code each treatment encounter.
 
"Part of the problem with prostate seed implants is that the codes billed by the radiation oncologist and those reported by the urologist are very different," says Cindy Parman, CPC, CPC-H, RCC, president of the AAPC National Advisory Board and co-founder of Coding Strategies Inc. in Powder Springs, Ga. Follow these expert tips to ensure you're choosing the right codes every time.

Don't Forget the Pre-Treatment Measurement

Before the physician can implant the radioactive seeds, the radiation oncologist or urologist must determine the size of the patient's prostate. This step is usually done by a transrectal ultrasound using very specialized ultrasonic radiological equipment, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.
 
If your urologist has this special equipment in his office or at the hospital and he himself performs the prostate measurements, you may report the service using code 76873 (Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]). Usually the radiation oncologist performs these measurements at the hospital where this specialized sonographic equipment is housed.
 
Caution: In order for you to report CPT 76873 , the urologist must perform the professional component of the ultrasound in the hospital outpatient department or perform the entire service in his office, Parman says. If the urologist performs this procedure in the hospital outpatient department, report 76873 with modifier 26 (Professional component) appended to indicate that the physician only performed the professional part of the service.

Beware of Separate Tasks

During the seed implantation process, the urologist and radiation oncologist will work closely but will perform distinctly separate parts of the procedure. Here's how you should report the separate tasks:
 
1. Placing the needle. Most often the urologist places the needles that are used to implant the seeds. Therefore, you'll report 55859 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) for transperineal placement of the needles.
 
The radiation oncologist should not report this code because it includes a cystourethroscopy, which only the urologist can perform. The cystoscopy is necessary to check if any seeds have been misplaced into the urethra or bladder lumen.

Brachytherapy is a treatment in which the physician implants radioactive seeds 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.

"When both a urologist and radiation oncologist work together on the prostate seed implant, the urologist typically reports this code instead of the 77xxx codes," Parman says.
 
2. Ultrasonic guidance. Remember to report the ultrasonic guidance your urologist uses for the needle placement. Use 76965 (Ultrasonic guidance for interstitial radioelement application) for this part of the procedure. Append modifier 26 because the urologist only performs the professional element of the ultrasound (i.e., the interpretation or reading of the ultrasound).
 
Since this procedure is performed in a hospital or ambulatory surgical center, the facility bills for the technical component. "Either the radiation oncologist or the urologist can report this code, but we usually see it billed by the urologist," Parman says.
 
3. Seed implantation. The radiation oncologist places the seeds, and reports 77776-77778 (Interstitial radiation source application ...). You shouldn't report these codes for your urologist's work. In the past, the urologists would place the seeds by an open procedure, billing 55860 (Exposure of prostate, any approach, for insertion of radioactive substance), but this method lacked the precision and localization of newer methods, Ferragamo says.
 
Note: Stay tuned to a future article of Urology Coding Alert to learn when and how you should bill for the brachytherapy markers.

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