Urology Coding Alert

Question: I'm wondering about coding for gold marker placement into the prostate. From what I can tell, these markers are placed using a transrectal ultrasound approach, much like the prostate biopsy procedure. I believe this is being done to achieve a planning target volume (PTV) for external beam radiation, thereby reducing the amount of field placement errors in brachytherapy. This is going to be started by one of our surgeons. How should I code for this?

Nevada Subscriber

Answer: You should use 53899 (Unlisted procedure, urinary system) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the procedure. Append modifier -26 (Professional component) to 76942 if performed in the hospital where your office does not own the imaging equipment. Be sure to send your operative notes to describe and explain the unlisted procedure.

There is no specific code for the gold markers themselves, so use 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies or materials provided]). The problem is Medicare does not pay for 99070, and the markers are rather expensive.

You should obtain a waiver for the markers if you intend to bill the patient. In some cases, the oncology department provides the markers, and if that's the case, you should not code for them.