Urology Coding Alert

As Medicare continues to scale back payment for prostate brachytherapy, it is more important than ever before for urologists to adopt a coding strategy for one of prostate brachytherapy's most time-intensive steps: clinical treatment planning. Clinical treatment planning is an in-depth process that involves the interpretation of special testing, prostate localization, and other procedures, the majority of which are coded 77263 (Therapeutic radiology treatment planning; complex). There is an additional study that may be done in prostate brachytherapy treatment planning that the urologist himself may elect to perform one week or so prior to seed insertion: 76873-26 (Echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]; professional component). This study is most often performed by the radiation oncologist, which is why urology Coders sometimes overlook coding and billing 76873-26 and only one physician can bill for the treatment plan, says Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm. The physician who assists or watches the procedure does not separately charge for his or her participation.

CPT Codes 76873 is for "volume and mapping that gives the physician an idea of where to insert the catheters or needles for the prostate seeds," says Craig McNabb, MBA, BSN, reimbursement manager for radiation for the Atlanta branch office of US Oncology, based in Houston. And if you are billing for the professional component of 76873 you must be sure to append modifier -26 (Professional component) for interpretation and application of the results of the test.