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Urology Coding Alert

Reader Question:

HDR Coding

Published on Sat Sep 01, 2001

Question: Our group has been performing brachytherapy, and we're interested in expanding into high-dose radiation for prostate cancer. How should we code for HDR?

Arkansas Subscriber
 
Answer: While not new, high-dose radiation is a kind of brachytherapy that has evolved in technology and patient selection and is becoming more popular.
 
HDR is similar to seed placement, except the implants are not left in the prostate. As with regular brachytherapy, in which the seeds remain in, HDR involves a urologist and radiation oncologist working as a team. The radiation is administered via catheters that go into the prostate. The urologist must perform the insertion of the catheters to make sure the radiation is delivered onto the prostate. Use 55859 (transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) for this procedure. This is the same code used for needle placement with permanent seed brachytherapy. The urologist also interprets the scan, billing 76965 (ultrasonic guidance for interstitial radioelement application) with modifier -26 (professional component) appended.
 
HDR is done in two separate sessions, each lasting about two days. For each session, the patient is admitted to the hospital, a CAT scan is performed, and the urologist places the catheters (55859). The radiation oncologist administers the radiation, and the catheters are sutured into the perineum while the patient remains in the hospital for 24 to 48 hours until the next treatment. The urologist does not perform any procedure for the second treatment -- it is administered by the radiation oncologist only.
 
For the second series, the patient returns to the hospital, and the entire two-day procedure is done again. This time, the urologist bills 55859-58 (staged or related procedure or service by the same physician during the postoperative period). The urologist must have clearly documented in the note before the first session that a second would be required. And the urologist again interprets the scan, billing 76965-26 (the procedure has zero global days, so modifier -58 is not required).
 
Besides the fact that the implants are temporary instead of permanent, an important difference between brachytherapy and HDR is that no prostate volume study is needed for HDR, although some urologists perform it anyway. Some urologists recommend external beam radiation after the brachytherapy itself. With HDR, it is possible to contour the shape of the radiation delivery, affording more control than with permanent seeds. Also, anecdotally, it seems to have fewer side effects than permanent seed placement.
 
-- Answers to You Be The Coder and Reader Questions provided by Michael A. Ferragamo, MD, assistant clinical professor of urology, State University of New York, Stonybrook; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver; John W. Scott, MD, assistant professor of urology, Indiana University; and Morgan Hause, CPC, CCS-P, coding specialist, Urology of Indiana.

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