Urology Coding Alert

Question: Our urologist completed gold seed marker placement in preparation for future cyberknife radiation therapy. How should I code for this, and what are the best diagnosis codes?

Alaska Subscriber

Answer: The correct procedure code for placement of gold seed markers is 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple). Notice that because the descriptor states “single or multiple” you only need to report 55876 once, irrespective of the number of devices placed during a single surgical session.

Freshen up your terminology: As a reminder, fiducial markers are pure gold seeds that help in identifying specific target points during radiation therapy. For this reason the surgeon implants the seeds in or around the prostate gland and tumor location.

Remember: You can also report any imaging guidance that was used. For example, you may report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). If you do not have a prior prostatic sonogram, you may also report 76872 (Ultrasound, transrectal) for sonographic examination of the prostate prior to the seed implantations.

If your office is supplying the tissue marker, you can also submit A4648 (Tissue marker, implantable, any type, each). Verify beforehand whether the insurer will reimburse for seed markers and for which your purchase invoice will be required for payment or whether the cost must be passed to the patient.

Diagnosis codes: Report any appropriate diagnoses based on the underlying condition that led to the implanted seed markers being placed. If a malignancy exists, the appropriate malignancy code for the primary or secondary lesion, based upon your physician’s documentation of the cancer, is reported.

For example, documentation may indicate malignancy of the prostate or related sites. ICD-10 codes common for this prostate procedure may be C61 (Malignant neoplasm of prostate), C79.82 (Secondary malignant neoplasm of genital organs), D07.5 (Carcinoma in situ of prostate), or D40.0 (Neoplasm of uncertain behavior of prostate).