Urology Coding Alert

Check out these tips before adding 52000 to one more brachytherapy claim Prostate brachytherapy can pose a challenge for urology coders because the treatment often crosses into other specialties. If you're not up to speed on which parts of brachytherapy you can code, you could be costing your urologist hundreds on each procedure. Tackle the three most common myths with these urology-specific tips.
Assess Division of Work Before Coding Myth #1: Since a radiation oncologist calculates the dosimetry of radiation and places the radioactive seeds, you won't be able to report the urologist's involvement in the procedure. Reality: If your urologist pairs with a radiation oncologist for a prostate brachytherapy procedure, the physician who places the needles or catheters into the prostate and typically performs the cystoscopy should report 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy), says Teresa A. Dailey, CPC, coding specialist for Urology Center of Spartanburg in South Carolina. If both physicians report this code, the payer will deny one of the claims. The AMA originally added the code for the urologist alone, and you should be using it only for the urologist, not the radiation oncologist. Take note: CPT 2007 changed the number (but not the descriptor) for this service from 55859 to 55875. Do this: For the ultrasonic guidance, report 76965-26 (Ultrasonic guidance for interstitial radioelement application; professional component), Dailey says. Appending modifier 26 indicates that the urologist performed only the professional component. Because this procedure is usually performed in a hospital, the facility will then bill for the technical component. Bottom line: Code for the services your urologist performs during the procedure, but avoid reporting CPT codes for services that the other physician performs, such as 77778 (Interstitial radiation source application; complex).
Separately Coding Cystoscopy Sets You Up for Denials Myth #2: When your urologist performs a cystoscopy after placing the seeds or brachytherapy needles, and the endoscopy is to evaluate a separate problem such as hematuria, rather than just to ensure correct seed position, you should separately report the cystoscopy. Reality: "Unfortunately, 55875 represents the transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy," Dailey says. So despite a separate diagnosis, you cannot unbundle 55875 and 52000 (Cystourethroscopy [separate procedure]). Red flag: Code 55875 includes several bundled column 2 codes under the Correct Coding Initiative (CCI), including specific urology catheterization codes 51701, 51702 and 51703 as well as cystoscopy codes 52000 and 52250. These urology code edits have a "0" modifier indicator, which means you can never override these CCI edits. On the other hand, if the urologist obtains a plain film of the pelvis and abdomen, [...]