Differentiate seeds and markers before choosing 55875 or 55876. Brachytherapy seed placement coding challenges even veteran coders because your urologist will likely work with another physician on the treatment, which limits what you can report. Overcome these challenges with three expert tips, and avoid costly brachytherapy denials. 1. Skip Separate Cysto Coding Traditionally, your urologist -- rather than the radiologist -- will place the needles to implant the brachytherapy seeds. You'll report this service with 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy), says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. Don't miss: According to the Correct Coding Initiative (CCI) 16.1, Medicare bundles 52000 into 55875,and you cannot bypass the edit with a modifier, Ferragamo stresses. Remember, however, some private and commercial payers may reimburse for the cystoscopic examination, so check with your individual payers. Additionally: If your urologist uses ultrasonic guidance to place the needles, you should report 76965 (Ultrasonic guidance for interstitial radioelement application) in addition to 55875. Append modifier 26 (Professional component) to indicate that your urologist performed only the professional component. Because this procedure is usually performed in a hospital, the facility will bill for the technical component. 2. Avoid the 55875 vs. 55876 Pitfall You might be tempted to report 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, prostate, single or multiple) for brachytherapy claims. According to the May 2007 CPT Assistant, however, you should report 55876 only when your urologist implants metallic marker seeds (also called fiducial markers) -- not brachytherapy needles or seeds -- into the prostate gland. The difference: In contrast: 3. Scour Documentation for Division of Services Typically, your urologist will work with a radiation oncologist to treat prostatic carcinoma with brachytherapy. Therefore, you need to pay extra attention to which physician performed which procedure so that you code only those services your urologist provided. If your urologist works with a radiation oncologist during a prostatic brachytherapy procedure, the physician who places the needles or catheters into the prostate and typically performs the cystoscopy should report 55875. If both physicians report the code, the payer will deny one of the claims. For example, the radiation oncologist will report 77778 (Interstitial radiation source application; complex) if he places the seeds using intracavitary radiation source application. Don't assume: Bottom line: