Urology Coding Alert

Question: How do we report for a gold seed marker placement for future cyberknife radiation therapy? Also, please suggest how to select the most appropriate diagnosis codes.

Alaska Subscriber

Answer: For placement of gold seed markers, you report code 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple). Submit 55876 only once irrespective of the number of devices placed during a single surgical session.

What are fiducial markers? Fiducial markers are pure gold seeds that are implanted in or around the place of tumor and which help in identifying the exact target points for the radiation therapy.

What is a dosimeter? A dosimeter is an instrument, which measures exposure to ionizing radiation.

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.

Also: Check with your payer and bill A4648 (Tissue marker, implantable, any type, each) for seed cost reimbursement when your practice bears the cost of supplying the tissue marker.

Diagnosis codes: Report appropriate diagnosis codes depending upon the underlying condition for which the implanted seed markers were placed. If a malignancy exists, the appropriate malignancy code for the primary or secondary lesion, based upon your oncologist’s documentation of the cancer, is reported.

Typically, gold seeds are implanted to provide a guide for directing radiation therapy for a cancerous condition.

Therefore, the most likely diagnosis would be a malignancy ICD-9-CM code.

For example, documentation may indicate malignancy of the prostate or related sites. Codes common for this procedure can be 185 (Malignant neoplasm of prostate), 198.82 (Secondary malignant neoplasm of genital organs), 233.4 (Carcinoma in situ of prostate), 236.5 (Neoplasm of uncertain behavior of prostate), or 239.5 (Neoplasm of unspecified nature of other genitourinary organs).