Wiki 55876 with 76965

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Can 76965 (Ultrasonic guidance for interstitial radioelement application)
be billed with 55876 (Placement of gold seed markers)?

I keep seeing guidelines that say 76965 may only be billed by the radiation oncologist or under the supervision of a radiation oncologist.

From Supercoder: The difference: ?Code 55876 is a placement of markers for measuring radiation doses or targeting radiation treatment,? says Linda Cahill, CPC, clinical coordinator/lead coder, for MidWest Urology Inc. in Cincinnati. ?The markers are visible by ultrasound and fluoroscopy, allowing an accurate triangulation of the tissue to be treated. This code reports the insertion of one or more of these capsules or markers.?

In contrast: ?Code 55875 is the placement of needles or catheters for the interstitial radioelement application/brachytherapy,? Cahill explains. ?The urologist would place the needles or catheters, and the radiation oncologist would place the radioactive isotopes or seeds [via these needles] into the prostate gland.?

I need to know if 76965 also applies to 55876 if the Urologist performs it.
They have previously been billing 76872 (ultrasound, transrectal) and this question has now come up if they should be using 76965 instead.

Thank you for any advice and help.
 
The urologists I worked for used to go both ways. sometimes they would place the seeds and sometimes the RadioOnc would do it. When my doctors did it I would code for it with the placement code (55876) and the US guidance code (see below) as directed in CPT.

For the ultrasound guidance, unless they were also completing a report for the transrectal ultrasound being billed (76872) then this would be inappropriate to bill as it is not an accurate depiction of the services performed, and cannot be supported with documentation. Ultrasound needle guidance is billed with 76942 and not 76965, because 76965 is US guidance for placement of interstitial radioelement application, which is not being performed. The gold seeds do not deliver radiation, they "allow for precision in targeting radiation and/or for measuring the radiation doses received....The inserted capsule may act as a fiducial marker, dosimeter, or, in many cases, will serve in both roles." (per Encoder Pro)

In the end, always bill for the US guidance in addition to the main procedure, as long as it is performed and you have documentation to support it.
 
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