Wiki Fiducial seed placement

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bziegman

bziegman

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We are having problems getting paid on some radiology charges. Do you know of anyone we can contact to get some advice for this area.

The procedure we are having problems on is called the “Fiducial seed placement” There are no CPT codes for this service and we have to use a miscellaneous code. We are putting the description in Box 19 of the insurance form, but this is no help.


Any assistance is greatly appreciated.
Belinda Ziegman, Supervisor of coding
 
Try this...

Hi,

I just recently was asked to bill for this and did some research. I came across an article on this topic, reviewed it with the urologist doing the procedure and he confirmed the information was correct for fiducial placement in the prostate. I just submitted last week so not sure how payer (Medicare) is going to handle it, but here it is:
55876 Fiducial placement,
76942 Ultrasonic guidance for needle placement, and
76872 Transrectal UTS

I put a Mod 25 on the 55876 and submitted. The article stated (and the urologist confirmed with me) that typically the radiation oncologist will provide the marker kit to the urologist (since the cost of the kit alone exceeds the Medicare reimbursement for the procedure of placing the markers).

Hope this helps,
Hunter Smith, CPC
 
If you referring to Placement of interstitial device(s) for radiation therapy guidance; eg, fiducial markers (gold seeds), there are several CPT codes for this depending on the anatomical area in which the markers are placed. Can you elaborate on the specific body areas and codes you are currently using?
 
hsmith67 said:
Hi,

I just recently was asked to bill for this and did some research. I came across an article on this topic, reviewed it with the urologist doing the procedure and he confirmed the information was correct for fiducial placement in the prostate. I just submitted last week so not sure how payer (Medicare) is going to handle it, but here it is:
55876 Fiducial placement,
76942 Ultrasonic guidance for needle placement, and
76872 Transrectal UTS

I put a Mod 25 on the 55876 and submitted. The article stated (and the urologist confirmed with me) that typically the radiation oncologist will provide the marker kit to the urologist (since the cost of the kit alone exceeds the Medicare reimbursement for the procedure of placing the markers).

Hope this helps,
Hunter Smith, CPC
Click to expand...

Hunter - would you be able to share this article? The oncologists that our urologist does these procedures for are telling us that WE have to purchase the fiducials - and they are quite expensive (we are not in the same group practice as the oncologists). They are claiming it is a Stark regulation, which I cannot locate information on. Thanks! Lisa

Also, mod -25 is not reportable on a surgical procedure - only on E/M's.
 
Article link

Lisa,
http://www.nysurologicalsociety.org/files/office_urological_procedures.pdf is the link for the article. Check the middle of page 3 for the relevant info -it is from 2007, but it was the first thing I found.

Also, I have found on CMS website the following regarding A4648 "Tissue marker, implantable, any type, each" being reimbursable effective 2/26/01 - read carefully to see if applies to your situation: http://www.cms.hhs.gov/Transmittals/Downloads/R604OTN.pdf


Thanks for the info on mod-25.

Regarding the group referring you to Stark, ask them to please provide the actual reference in Stark that supports their claim. Not saying they are wrong, but we all know how misinformed people incorrectly and overzealously interpret HIPAA every day.

Hope this helps,
Hunter Smith, CPC
 
baneitz

Our Neurosurgeons are placing Fudicial markers for deep brain stimulation. There are no codes for this and we are uncertain how to bill for this.

Any suggestions would be appreciated.
Thanks...
 
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