Medical Oncology Code Changes
ACOA’s Coding Corner – May 2006
Fiducial Marker
There are a number of questions surrounding coding and billing for services
related to the implantation of fiducial markers. The following are some
quick tips:
·
The Federal Register, November 7,
2003 (OPPS Final Rule) stated that the supply cost of the fiducial markers
is included in reimbursement for IMRT and SRS services.
o
While hospitals have a code to report the
purchase of the markers to Medicare [C1879, tissue marker
(implantable)], it is not separately reimbursed.
·
In some situations, Medicare Part B will
reimburse for the markers when they are purchased by a physician and
implanted in the physician's office. For example:
o
NY Medicare states: "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..."
·
The surgical service to implant the markers
is generally reported with an unlisted procedure code for the insertion and
a code for the imaging guidance that was used. For example:
o
55899, unlisted procedure male genital system and
76003, fluoroscopic guidance for needle placement (e.g., biopsy,
aspiration, injection, localization device)
It may also be beneficial to check with
your local insurers to see if there are any local policies that provide for
marker reimbursement.
Watch for more
coding changes in the upcoming months. Review previous Coding and
Reimbursement Updates.
This Coding and
Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.
Phone: (877) 6CODING
Fax: (770) 445-0407
Cindy.Parman@codingstrategies.com
www.codingstrategies.com
Cindy
C. Parman, CPC, CPC-H
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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