Urology Coding Alert

Question: My urologist performs brachytherapy in an ambulatory surgery center, and we've been hearing conflicting information about whether we can report these services. Can you tell me what the latest decision from CMS is?

New York Subscriber

Answer: Just before 2007 ended, CMS offered am-bulatory surgery centers (ASCs) an answer that finally ends the speculation about whether ASCs can bill Medi-care for brachytherapy services that their physician-owners provide in their ASCs. The new answer is: Yes, they can.

The confusion existed "because brachytherapy sources are subject to the Stark self-referral prohibition as a radiation therapy supply that, under the new ASC payment system, will be reimbursed separately from the ASC facility fee and, thus, will not be eligible for the exception to the Stark law for facility fee items and services," according to a Dec. 20 news clarification from Kathy Bryant, chief executive officer of the Ambulatory Surgery Center Association, based in Alexandria, Va.

In addition, Bryant said, "ASCs that furnish brachytherapy services may take full advantage of expanded coverage for brachytherapy sources without any Stark law concerns."

Bottom line: Medicare's decision noted that brachytherapy qualifies for a separate Stark exception for implants that physicians provide in the ASC (such as durable medical equipment and prosthetics).

A new Q&A on the CMS Web site confirms that the agency is "interpreting 42 C.F.R. § 411.355(f) to include implanted brachytherapy sources," allowing brachytherapy to qualify as an exception to the self-referral ruling in ASCs.