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
[email protected]
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.