How To Use CPT Code 55876

CPT 55876 describes the placement of interstitial device(s) for radiation therapy guidance in the prostate. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55876?

CPT 55876 involves the placement of interstitial device(s) in the prostate for radiation therapy guidance. These devices, such as fiducial markers or dosimeters, are inserted into tissue gaps within the prostate using a needle. The purpose of this procedure is to assist in the accurate administration of radiation treatment.

2. Official Description

The official description of CPT code 55876 is: ‘Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple. Note: Report supply of device separately. For imaging guidance, see 76942, 77002, 77012, 77021.’

3. Procedure

1. The provider begins by performing a digital rectal examination to assess the patient’s prostate.
2. Under ultrasound guidance, the provider inserts a needle into the prostate.
3. Using the needle, the provider places one or more fiducial markers or a dosimeter in the target area of the prostate.
4. After the devices are inserted, the provider removes the transrectal ultrasound probe and irrigates the area.
5. The provider checks for any bleeding and ensures that all instruments are removed.
6. Finally, the provider closes the incision.

4. Qualifying circumstances

CPT 55876 is performed on patients who require radiation therapy for prostate cancer. The procedure involves the placement of interstitial devices, such as fiducial markers or dosimeters, to guide the administration of radiation treatment. These devices are inserted into tissue gaps within the prostate using a needle. The procedure is typically performed by a provider who specializes in radiation oncology.

5. When to use CPT code 55876

CPT code 55876 should be used when a provider places interstitial device(s) in the prostate for radiation therapy guidance. This code is appropriate for both single and multiple device placements. It is important to note that CPT code 55876 should not be reported if imaging guidance is used during the procedure, as separate codes exist for that purpose.

6. Documentation requirements

To support a claim for CPT code 55876, the provider must document the following information:

• Patient’s diagnosis and the need for radiation therapy guidance
• Specific interstitial device(s) placed, such as fiducial markers or dosimeters
• Date of the procedure
• Details of the procedure, including the use of ultrasound guidance
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 55876, ensure that the procedure involves the placement of interstitial device(s) in the prostate using a needle. Report the supply of the device(s) separately. If the provider also performs the ultrasound guidance, the professional component can be reported using the appropriate ultrasound codes with modifier 26. It is important to review the specific billing guidelines of the payer to ensure accurate reporting.

8. Historical information

CPT code 55876 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates or changes to the code since its addition.

9. Examples

1. A radiation oncologist placing fiducial markers in the prostate of a patient prior to radiation therapy.
2. A urologist inserting dosimeters into the prostate to guide the administration of radiation treatment.
3. A radiologist placing interstitial devices in the prostate using ultrasound guidance for accurate radiation therapy.
4. A radiation oncology team inserting multiple fiducial markers in the prostate to ensure precise targeting of radiation.
5. A provider placing interstitial device(s) in the prostate of a patient with prostate cancer to assist in the delivery of radiation therapy.
6. A radiation therapist inserting dosimeters into the prostate to measure radiation dosage during treatment.
7. A urologist placing fiducial markers in the prostate using a needle for radiation therapy guidance.
8. A radiologist performing the placement of interstitial device(s) in the prostate with imaging guidance for accurate radiation treatment.
9. A radiation oncology team using ultrasound guidance to insert fiducial markers in the prostate for precise radiation therapy.
10. A provider placing interstitial device(s) in the prostate of a patient to guide the administration of radiation treatment.