Two new HCPCS Codes for prostate brachytherapy deliver marked changes in hospital billing for treatment of Medicare patients and if you don't know what is included in these new G codes, you won't be safe from your next Medicare audit.
Effective Jan. 1, 2003, for hospital APC billing purposes, the following temporary codes for palladium-103 (Pd-103) and iodine-125 (I-125) replace all CPT Codes previously used for coding prostate brachytherapy rendered to Medicare patients:
Coders should note that these new G codes are for hospital APC billings only and do not apply to coding for the individual urologist.
During brachytherapy treatment, a urologist and a radiation oncologist often work side-by-side to implant radioactive seeds in the prostate. The urologist alone should still code and bill 55859 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) for the surgical component of the brachytherapy, i.e., for the insertion and placement of the needle for the delivery of the seeds, as well as 76965-26 (Professional component) for ultrasonic guidance.
For 2003, CMS bundles urethral catheter codes 51701, 51702 and 51703 into code 55859, and no modifiers can unbundle these services.
Nevertheless, some private carriers will reimburse for the catheter placements if performed. The American Urological Association also considers misplaced seed removal during a cystoscopy (52310 or 52315) immediately following implantation not a billable service. In this scenario, seed removal is considered an integral part of the surgery. However, seed removal at a later date, if done within the 90-day global period of the initial procedure, may be coded 52310 or 52315 with modifier -78 (Return to the operating room for a related procedure during the postoperative period), indicating that the seed removal was a treatment for the complication of displaced seeds.
The two new G codes for "permanent prostate seed implants" now include both the urology code, 55859, the application code, 77778, as well as the seeds themselves, says Jim Hugh, MHA, senior vice president with AMAC, a reimbursement and billing firm based in Atlanta that serves radiation oncology practices and hospitals.
But remember that the urologist still bills the above urological codes. Only hospitals have the codes bundled into one of the new G codes, says Cindy Parman, CPC, CPC-H, [...]