Coding Q&A: Radiation
Disclaimer: Answers to incoming questions are provided by the members of the Society of Gynecologic Oncology (SGO) Coding and Reimbursement subcommittee and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.
How do you code for the insertion of a Smit/cervical sleeve?
There is no code for Smit sleeve insertion. The most appropriate way to code this procedure is to use the 57155 (insertion of tandem and ovoids) code with a -52 modifier to reflect reduced work for the procedure
How do you code for placement of Heyman’s capsules?
Report code 58346 (Insertion of Heyman capsules for clinical brachytherapy).
How do you code for placement of tandem/ovoids for brachytherapy?
Gyn oncologists should use code 57155 (insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy). Use modifier 76 (repeat procedure by the same physician) for subsequent treatments. Radiation oncologists will bill for insertion of radioactive elements using separate codes.
How do you bill for insertion of vaginal applicator device in High Dose Rate (HDR) brachytherapy?
Code 57156: insertion of a vaginal after-loading apparatus for clinical brachytherapy
How does one bill for placement of fiducial markers/seed markers at the time of placement of a cervical/Smit sleeve for brachytherapy?
Use 57800, add -22 modifier. This will require a copy of the procedure note to obtain additional reimbursement.
Is there a laparoscopic code for the open procedure code 58825 (Transposition, ovary(s))?
There is no corresponding laparoscopic code to 58825. You can report code 58679 (unlisted laparoscopy procedure, oviduct, ovary). If an unlisted procedure code is reported, the claim should be filed manually (paper claim) with a copy of the operative note and a brief explanation of the procedure and reason for the unlisted code. Alternatively, you might report code 58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) to justify any manipulation of the ovary. The lysis of adhesions must be well documented. As a point of information, the RVUs for codes 58825 and 58860 are very similar.
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