You Be the Coder:
Prostate Cryosurgery
Published on Thu Nov 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our group is starting to bill for prostate cryosurgery. What is the correct coding for both the procedure and the diagnosis?
Indiana Subscriber
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Answer: Use CPT code 55873 (cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]). The only appropriate diagnosis code is 185 (malignant neoplasm of the prostate). As of July 1, Medicare does cover cryosurgery performed after a failed first trial of radiation therapy. Medicare previously had no national policy covering salvage prostate cryosurgery.
Note that this new procedure code (55873) includes the ultrasonic guidance for the probe placement, and therefore replaces old HCPCS codes G0160 (cryosurgical ablation of localized prostate cancer, primary treatment only [postoperative irrigations and aspiration of sloughing tissue included]) and G0161 (ultrasonic guidance for interstitial placement of cryosurgical probes).
If you perform the ablation, and another provider provides the ultrasonic guidance, you must submit your claim, and the other provider must seek compensation from you. Medicare recognizes that although two physicians may be involved, the procedures performed are usually done concurrently and should be provided by one physician. Since reimbursement to the primary physician includes allowance for other procedures, it is up to the primary physician to pay the other physician.
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