Gynecologic Brachytherapy Procedures
CPT code 57156, insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy, was added to describe the work associated with vaginal brachytherapy. The process of care for this code involves placement of an applicator in a patient prior to brachytherapy treatment. This code should be utilized for the placement of a vaginal cylinder, or ovoids, or similar afterloading device for subsequent brachytherapy, typically in a post hysterectomy patient. This code was added to more accurately describe this procedure as previously, radiation oncologists used various codes listed below to describe this process. The remaining codes describe work associated with other gynecologic applicator placement procedures and are still active.
| CPT code | Description |
|---|---|
| 55920 | Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application |
| 57155 | Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy |
| 58346 | Insertion of Heyman capsules for clinical brachytherapy |
| 58999 | Unlisted procedure, female genital system (nonobstetrical) |
The work of CPT code 57156 describes preparing a patient and inserting and securing the vaginal applicator. It also includes the removal of the applicator after the procedure has been completed. Additional codes would be appropriate for subsequent procedures, depending on the actual work done. For example, simulation, clinical treatment planning, isodose treatment plan and basic radiation dosimetry may be a component of the preparation for treatment. The actual brachytherapy treatment code utilized depend on whether this applicator is used for low-dose-rate or high-dose-rate brachytherapy.
CPT code 57156 belongs to Ambulatory Payment Classification (APC) 5412 for reimbursement. CPT codes 55920, 57155, and 58346 belong to APC 5415 and CPT code 58999 belongs to APC 5411. Appropriate documentation of the insertion procedure is required. This code would be used once per day but may be required multiple times during the course of treatment.
Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2020, American Medical Association. All Rights Reserved.
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