Prostate SBRT

[msuxrt]

Is there a code for urologists to be involved in SBRT planning like there is for Neurosurgeons?

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[BobbyHeenan]

Is there a code for urologists to be involved in SBRT planning like there is for Neurosurgeons?

Following a long for this answer as well.

I *think* there's an unlisted code but I think very rarely it ever gets reimbursed.

When I trained a decade ago we did have pulm and urologist sometimes "help" with SBRT, but this was all a billing shell game to get them more involved and invested in the process more than actual help.

Obviously there's no financial incentive if they don't get billed but in my experience if they look at a planning CT or MRI and then watch real time fiducial tracking they often seem to understand the process better...especially if they did the fiducials or spaceOAR. With that said, it's still time out of their busy schedule that isn't reimbursed, so the enthusiasm on having them regularly involved in planning/delivery is minimal.

 

[medgator]

Is there a code for urologists to be involved in SBRT planning like there is for Neurosurgeons?

There's a thoracic code for lung SBRT as well, it escapes me at the moment

 

[deleted1111261]

There's a thoracic code for lung SBRT as well, it escapes me at the moment

There is not for urology, there is for pulmonary.

 

[CptCrunch]

There's a thoracic code for lung SBRT as well, it escapes me at the moment

32701 for thoracic. I haven't heard of one for urology before.

 

[BobbyHeenan]

There is not for urology, there is for pulmonary.

Do you know if it's being paid by medicare or private insurers?

 

[dieABRdie]

32701 for thoracic. I haven't heard of one for urology before.

Thanks for this.

What exactly do they do? Review target delineation? Aetna describes as "Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment"

Does it need to be a surgeon.... or maybe could also be the interventional pulmonologist?

 

[dieABRdie]

Maybe some urology groups are trying....

How to bill for radiation treatment planning

We would recommend for best practices that the urologist reviewing treatment planning for CyberKnife include in the patient record a clear indication that the radiation oncologist’s treatment plan was reviewed in detail.

www.urologytimes.com

"Our clinic is doing some research on CyberKnife Radiation Therapy treatment planning for one of our urologists. We have had difficulty for some time now obtaining reimbursement from our Medicare provider, WPS. Our urologist places the fiducial seeds and then helps the radiation oncologist with the CyberKnife Therapy treatment planning. We know that we have to use the unlisted procedure code 55899 for the urologist’s portion of the treatment planning, since the radiation oncologist bills the 77263 code. We provide a description of the service in box 19 of the claim as they request. We provide the documentation of the treatment plan from the radiation oncologist’s office and our physician dictates a brief note. Are you aware of any best practice documentation guidelines for the urologist’s portion of his services? We have been unable to find anything thus far."

 

[CptCrunch]

Thanks for this.

What exactly do they do? Review target delineation? Aetna describes as "Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment"

Does it need to be a surgeon.... or maybe could also be the interventional pulmonologist?

Link to the Varian coding guide:

LungSBRTTargetDelineation_CodingGuide_RAD10301I_June2021.pdf

varian.widen.net

 

[deleted1111261]

I haven’t tried to collect the charge yet but working on this with pulm group.

 

[Gfunk6]

The only planning code that is reimbursed is for Neurosurgeons. Urologists and Pulmonologists technically have an unlisted code as mentioned above, but we've never gotten paid on the few occasions we've tried to bill it.

 

[deleted1111261]

The only planning code that is reimbursed is for Neurosurgeons. Urologists and Pulmonologists technically have an unlisted code as mentioned above, but we've never gotten paid on the few occasions we've tried to bill it.

GF- I don’t think the pulm one is unlisted .. it’s legit for them and thoracic surgeons

 

[seper]

We have a Urology attending “assist” in fiducial and SpaceOAR placement in OR and they bill something for that, which makes them very very happy and engaged

 

[medgator]

We have a Urology attending “assist” in fiducial and SpaceOAR placement in OR and they bill something for that, which makes them very very happy and engaged

Definitely been going on since the age of brachy