Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

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Medical Oncology Code Changes

ACOA’s Coding Corner – September 2005

Fiducial Marker Placement

According to the CPT Manual: “Select the name of the procedure or service that accurately identifies the service performed.  Do not select a CPT code that merely approximates the service provided.  If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code.”

Based on this information, and because there is no specific code for marker insertion, it is necessary to report an ‘unlisted’ code for the insertion of fiducial markers and send a report to the insurance payor.  For example:

55899  Unlisted male genital procedure

76003  Fluoroscopic guidance, or

76942  Ultrasound guidance

The gold seed markers are considered to be supplies for Medicare, and there is generally no separate reimbursement for supplies.  CMS published information for hospitals in the 11/07/2003 Federal Register that indicates the ‘fiducial screws’ would be maintained on the list of supplies for IMRT treatment.

NY Medicare is one Part B carrier that covers gold seeds and has the following published policy:

“Reimbursement for the cost of the gold seed markers, when performed in the non-facility office setting, will be reimbursed at invoice price.  When billing Medicare B for the cost of the gold seed markers, code A4649 (surgical supply, miscellaneous) should be billed.  Medicare will request an invoice and will reimburse for the cost of the markers at the invoice price…”

When in doubt regarding coverage, it may be necessary to contact local payors for their individual guidance.

Watch for more 2005 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates from the Academy’s Website.

This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.

Phone: (877) 6CODING

Fax: (770) 445-0407

[email protected]
www.codingstrategies.com

Cindy C. Parman, CPC, CPC-Hcparman-8528895
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.  

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