Coding for Fiducial Markers

Fiducial markers serve as radiologic landmarks. The marker(s) is placed in or near a tumor, under imaging guidance, and becomes the “target” to facilitate precise delivery of radiation treatments. Two codes describe placement of these devices in soft tissue (not including breast):

10035 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion
+● 10036 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure)

You should report 10035 and 10036 per lesion, not per marker (several markers may be placed, per lesion). Claim 10035 for placement of soft tissue markers at an initial lesion, and add-on 10036 for each additional lesion targeted, beyond the first.
CPT® includes several codes that specifically describe placement of localization devices in the breast, either with (19081-19086) or without (19281-19288) biopsy. CPT Changes 2016 clarifies, “10035 and 10036 have been established to capture marker placements into areas such as the axilla and/or groin tissue.” Do not report 10035/10036 if 19081-19086 or 19281-19288 better describe the location of the marker.
Note that marker placement includes imaging guidance: do not separately report 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation, or 77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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