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Ob-Gyn Coding Alert

Reader Question:

Brachytherapy

Published on Sun Jul 01, 2001

Question: What is the correct billing for brachytherapy? My doctor is a gyn-oncologist who assisted a radiation oncologist with intra-abdominal guidance of interstitial needles. She also did an exploratory laparotomy, bilateral lymph node dissection, cervical dilation and a prophylactic appendectomy. There were 29 needles and one intrauterine tandem placed. Several needles needed to be repositioned. She also sutured marker balls on the cervix, one at 12 o'clock and one at 6 o'clock on the vaginal wall. How do I bill for both physicians?

California Subscriber
 
 Answer: You can bill for the bilateral lymph node dissection using the code that describes which nodes were removed (38760-38780). Do not bill for the exploratory or the cervical dilation. This is part of the intracavitary placement code, 77761 or 77762 (intracavitary radiation source application; ...), which the radiation oncologist will bill. The gyn surgeon will bill the same code and add modifier -62 (two surgeons). The radiation oncologist will also bill one of the 77776-77778 (interstitial radiation source application; ...) codes for the interstitial needles, as will the physician, appending modifier -62. You will probably not get paid for the appendectomy, but you can try to bill for it using 44950-52 (appendectomy, -reduced services), because it appears to be an incidental procedure in this case. Fortunately, CPT is considering adding a code or two for the placement by the surgeon of ovids, tandems and heyman capsules in the near future.

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