Radiology Coding Alert

Much-needed codes for interstitial device placement in specific anatomic areas continue to trickle in to the CPT manual. CPT 2010 adds codes for percutaneous intra-thoracic and intra-abdominal/intra-pelvic placement, and it tweaks the existing prostate placement code's descriptor. Thoracic: You will use 32553 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter] percutaneous, intra-thoracic, single or multiple) for device placement in the thorax, states an American College of Radiology (ACR) 2010 CPT Code Update (head to www.acr.org/hidden/economics.aspx, click on "The ACR Radiology Coding Source," and search the archives for Sept./Oct. 2009).

Abdominal/Pelvic: For placement within the abdomen, pelvis, and retroperitoneum, you'll turn to 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple), the ACR explains. Having specific codes such as 49411 is certainly beneficial for coding placement of the fiducial markers, says Erin Goodwin, CPC, CMC, director of radiation reimbursement for South Carolina Oncology Associates in Columbia.

Prostate: Note that 49411 excludes prostate placement, which you'll continue to report using 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, prostate, single or multiple). This updated descriptor simply exchanges "via needle, any approach" for "percutaneous," bringing the wording in line with the new codes' descriptors. You should continue to report 55876 to describe the transrectal approach for fiducial marker placement in the prostate, the ACR says.

Report separately: As with prostate device placement, CPT states you may report imaging guidance (76942, 77002, 77012, 77021) and the devices (such as A4648-A4650) in addition to the procedure codes (32553, 49411, 55876), assuming you provide those items.