Urology Coding Alert

With more than $700 per procedure on the line, keeping the physicians' roles straight is crucial Brachytherapy presents a vexing coding scenario, thanks to the multitude of physicians who perform this service across specialties. To code correctly for this popular treatment method for prostate cancer, you have to understand which parts of the brachytherapy procedure the urologist is responsible for. Let the answers to these frequently asked questions clear up the seeds of coding confusion. Who Does What During a Brachytherapy Procedure? In brachytherapy, a radiation oncologist places low-dose radioactive seeds into a cancerous prostate to deliver radiation directly. Before the procedure, the oncologist measures the prostate and calculates the dosimetry of radiation. And during the procedure, the oncologist is the one who actually places the radioactive seeds, says Becky Sweat, CPC, coder and business services coordinator for the department of urology at Wake Forest University Health Services in Winston-Salem, N.C.

Using ultrasonic guidance, the urologist guides needles into the prostate through the perineum. "Then the oncologist comes in and puts the seeds in" through the needles, Sweat says. To make sure the seeds are in the right place, the urologist then visualizes the prostate through cystoscopy, fluoroscopy or x-ray.

Do this: Use 55859 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) for the urologist's needle or catheter insertion, says Jennifer Vanderhorst, CPC, coder for Michigan Urological Clinic in Grand Rapids. For the ultrasonic guidance, Vanderhorst says, use 76965-26 (Ultrasonic guidance for interstitial radioelement application; professional component). Appending modifier -26 indicates that the urologist performed only the professional component. Because this procedure is performed in a hospital or ASC, the facility will bill for the technical component.

Red flag: Cystoscopy is always included in 55859, Vanderhorst says, so don't bill separately for cystoscopy to evaluate the seed placement. However, if the urologist x-rays the pelvis and abdomen, report 74000-26 (Radiologic examination, abdomen; single anteroposterior view; professional component).

Link all these procedures to ICD-9 Code 185 (Malignant neoplasm of prostate). Should the Urologist and the Oncologist Code as Cosurgeons? No, Sweat says. Each surgeon has his own set of specific procedures to perform, and each procedure has a CPT Codes that accurately describes the work. No single CPT code encompasses all the work done, so there's not a CPT code that two surgeons can "share."

"You cannot use either modifier -62 (Two surgeons) or modifier -80 (Assistant surgeon) with 55859," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York in Stony Brook. Medicare payment policy will not allow [...]