The Centers for Medicare & Medicaid Services (CMS) released 25 corrections to the 2012 HCPCS Level II ANWEB file. The corrections, released Jan. 30, include description and ambulatory surgery center (ASC) indicator changes, removal of codes, updated Berenson-Eggers Type of Service (BETOS) information, and revised effective dates.
Terminated or Removed
C9716 Creations of thermal anal lesions by radiofrequency energy should be terminated effective Jan. 1, 2012.
G0449 Annual face-to-face obesity screening, 15 minutes will not be created. Remove from file.
G0450 Screening for sexually transmitted infections, includes laboratory tests for chlamydia, gonorrhea, syphilis and hepatitis B will not be created. Remove from file.
Revised Descriptions
G0446 Long description Intensive behavioral therapy to reduce cardiovascular disease risk, individual, fact-to-face, >annual<, 15 minutes is revised effective Nov. 8, 2011.
G8553 Both short description (Prescrip transmit via ERx sy) and long description (Prescription(s) generated and transmitted via a qualified ERx system) are changed effective Jan. 1, 2012.
J1561 Short description Gamunex, Gamunex-C, Gammaked is changed effective Jan. 1, 2012.
Revised Effective Dates
G0442 Annual alcohol misuse screening, 15 minutes is now effective Oct. 14, 2011.
G0443 Brief face-to-face behavior counseling for alcohol misuses, 15 minutes is also effective Oct. 14, 2011.
K0743 Suction pump, home model, portable, for use on wounds is now effective July 1, 2011.
Revised Indicators
C1886 Catheter, extravascular tissue ablation, any modality (insertable)—Add ASC “YY” indicator, effective Jan. 1, 2012.
C9728 Placement of endorectal intracavitary applicator for high intensity brachytherapy—Add ASC “YY” indicator, effective Jan. 1, 2008.
C9732 Insertion of ocular telescope prosthesis including removal of crystalline lens—Add ASC “YY” indicator, effective Jan. 1, 2012.
G0448 Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing—Change TOS to “2,” effective Jan. 1, 2012.
J2265 Injection, minocycline hydrochloride, 1 mg—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4123 Alloskin RT, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4125 Arthroflex, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4126 Memoderm, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4127 Talymed, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4128 FlexHD or Allopatch HD, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4129 Unite biomatrix, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
J8561 Everolimus, oral 0.25, mg—Change BETOS to “01E,” effective Jan. 1, 2012.
CMS recommends updating data files as well as noting changes in codebooks.
February 10th, 2012
By Erin Goodwin, CPC, and G.J. Verhovshek, MA, CPC
Radiation therapy must target cancerous cells precisely, while sparing as much surrounding healthy tissue as possible. Placing small metal “seeds” (typically made of gold or stainless steel), called fiducial markers, at the exact site of a malignancy allows the radiation oncologist to pinpoint that location when delivering radiation. In simple terms, the markers serve as landmarks. To ensure correct placement, the markers are implanted under imaging guidance.
Location and Method Matters
Placement of fiducial markers may be coded as a separately reimbursable procedure. Which code you select (and whether you may additionally report imaging guidance) will depend on the location and, in some cases, the method of placement.
For intrathoracic (e.g., lungs or pleura) placement by a percutaneous approach, select 32553 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple. Code 32553 is a standalone code, and does not include imaging guidance. You may report imaging guidance separately:
- For ultrasonic guidance, use 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
- For fluoroscopic guidance, use 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device).
- For CT guidance, use 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation.
- For MRI guidance, use 77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation.
If the marker is delivered by a bronchoscope via the airway, instead report 31626 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple. As a standalone code, 31626 includes fluoroscopic guidance and moderate sedation, when performed. This code is appropriate, for instance, when the physician places fiducial markers to help visualize lung wedge biopsy.
For the abdomen, omentum, pelvis (excluding the prostate), peritoneum, or retroperitoneum, select an appropriate code by method of insertion:
- For laparoscopic placement, select +49327 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure). This is an add-on code reported with the code for the concurrent abdominal, intrapelvic, and/or retoperitoneal laparoscopic procedure.
- For percutaneous placement, report 49411 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple. This standalone code includes moderate sedation, when provided, but does not include imaging guidance. You may report guidance separately using 76942, 77002, 77012, or 77021, as appropriate.
- For open placement by surgical incision, report +49412 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure). This is an add-on code reported with the concurrent open abdominal, intrapelvic, and/or retoperitoneal procedure code. Code 49412 includes imaging guidance.
For example, the American Medical Association’s (AMA’s) CPT® Changes 2011: An Insider’s View, describes a scenario in which a 67-year-old female “is found at the time of laparotomy to have an unresectable pancreatic adenocarcinoma in the head of the pancreas. Tracking fiducial implants are placed for later stereotactic radiation treatment.” The planned laparotomy is reported as the primary procedure, with 49412 as an add-on to describe placement of the fiducial markers.
For fiducial marker placement into the prostate, report 55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple. This is a standalone code and does not include imaging guidance. You may report guidance separately using 76942, 77002, 77012, or 77021, as appropriate to the type of imaging used.
For any location not described by one of the above codes, turn to HCPCS Level II code C9728 Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), for other than the following sites (any approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or multiple. This standalone code describes any approach, but does not include imaging guidance. You may report guidance separately using 76942, 77002, 77012, or 77021, as appropriate.
Fiduciary Marker Placement Coding at a Glance
| APPROACH |
SITE
|
| Intrathoracic |
Abdomen, omentum, pelvis (excluding prostate), peritonem, retroperitoneum |
Prostate |
Other
location |
| Percutaneous |
325532 |
494112,3 |
|
|
| Bronchoscopy |
316263 |
|
|
|
| Laparoscopic |
|
493271 |
|
|
| Open |
|
494121 |
|
|
| Any approach |
|
|
558762 |
C92782 |
1. Add-on code: Report in addition to primary procedure
2. Report imaging guidance separately
3. Includes moderate sedation
Multiple Markers Won’t Change Coding
Codes 31626, 32553, 49327, 49411, 49412, 55876, and C9278 all describe placement of one or more markers. Don’t report multiple code units if the physician places more than one marker at a given location.
Marker Supply Isn’t Included
Placement codes do not include supply of the markers (e.g., A4648 Tissue marker, implantable, any type, each). The supply would be reported by the facility, not the performing physician. In the hospital outpatient setting, Medicare states that the payment for placements includes the implantable devices. Private payers may provide separate payment for fiducial markers; check with your payer for instruction.
Don’t Confuse Markers with Radioactive Seeds
Some types of cancer may be treated by implanting radioactive interstitial devices, which may be delivered by needle or catheter, at the site of cancerous cells. These radioactive “seeds” affect the malignant tissue directly. For example, 55875 Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy describes placement of needles or catheters into the prostate to allow delivery of such radioactive devices. Do not confuse these interstitial devices with fiducial markers; fiducial markers do not deliver radiation, but act as guides in the delivery of external radiation therapy.
Erin Goodwin, CPC, is the director of radiation reimbursement at South Carolina Oncology Associates, PA. She has worked in oncology for over 13 years. She is an active member of her local AAPC Chapter, Capitol Coders, in Columbia, S.C. where she was the new member development officer in 2008.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
July 1st, 2011