Urology Coding Alert

Question: What codes should we use for prostate brachytherapy or seed implantation for prostate cancer in the hospital outpatient setting?

North Carolina Subscriber

Answer: For the urologist, you would report 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy).

If your urologist uses ultrasonic guidance, you can also report 76965 (Ultrasonic guidance for interstitial radioelement application). Append modifier 26 (Professional component) since your urologist is performing the procedure in the hospital outpatient setting using the facility's equipment.

Private payer bonus: For some private payers, you may also be able to report the catheter insertion (assuming your urologist does this) using 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]). However, Medicare and some private payers include the urethral catheterization with 55875.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.