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The CPT® Code 57156 refers to the insertion of a vaginal radiation afterloading apparatus specifically for clinical brachytherapy. This procedure is a form of internal radiation therapy that is commonly utilized in the treatment of uterine cancer, particularly after a hysterectomy has been performed. The primary goal of vaginal brachytherapy is to deliver targeted radiation to the upper vaginal region, which is at a heightened risk for cancer recurrence. The procedure involves the use of a specialized cylinder apparatus that is inserted into the vagina, allowing for precise placement of the radiation source. Prior to the procedure, the bowel is prepared using a Fleet enema to ensure optimal conditions for treatment. During the procedure, the patient is positioned supine with feet in stirrups, and the perineal and genital areas are thoroughly cleansed to maintain sterility. Catheters are then placed in the bladder and rectum to facilitate imaging and ensure proper positioning of the radiation apparatus. The physician carefully inserts the vaginal cylinder and secures it in place, followed by the injection of contrast material into the bladder and rectal catheters. This imaging step is crucial for evaluating the cylinder's position relative to surrounding organs, which aids in the development of a tailored treatment plan. The physician subsequently delivers the prescribed radiation dose through the channels of the cylinder, ensuring that the treatment is focused on the areas at risk while minimizing exposure to adjacent healthy tissues. After the completion of the brachytherapy, the vaginal cylinder, along with the bladder and rectal catheters, is removed, concluding the procedure.
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The procedure described by CPT® Code 57156 is indicated for patients who have undergone a hysterectomy due to uterine cancer and are at a high risk for cancer recurrence. The use of vaginal brachytherapy is particularly relevant in cases where there is a need for localized radiation treatment to the upper vaginal region to prevent the return of cancer. This procedure is typically considered when other treatment options may not provide the same level of targeted therapy.
The procedure for the insertion of a vaginal radiation afterloading apparatus involves several critical steps to ensure effective treatment. First, the bowel is prepared with a Fleet enema the night before the procedure to clear the rectal area. On the day of the procedure, the patient is positioned supine with their feet placed in stirrups to facilitate access. The perineal and genital areas are then cleansed thoroughly to maintain a sterile environment. Following this, catheters are inserted into the bladder and rectum to allow for imaging and monitoring during the procedure. The physician then carefully inserts the vaginal cylinder into the vagina, ensuring it is secured properly to maintain its position throughout the treatment. Once the cylinder is in place, contrast material is injected into the bladder and rectal catheters. This step is crucial as it allows the physician to obtain images that evaluate the positioning of the cylinder in relation to surrounding organs, which is essential for effective treatment planning. After reviewing the images, the physician creates a tailored treatment plan that specifies the radiation doses and exposure amounts necessary to target the sites at risk for cancer recurrence while minimizing radiation exposure to adjacent healthy tissues. Finally, the physician delivers the prescribed radiation dose through the channels of the vaginal cylinder, completing the brachytherapy procedure. Upon completion, the vaginal cylinder, along with the bladder and rectal catheters, is removed, concluding the treatment process.
After the completion of the brachytherapy procedure, patients may experience some discomfort or mild side effects, which should be monitored. It is essential for healthcare providers to provide appropriate post-procedure care instructions, including any necessary follow-up appointments to assess the treatment's effectiveness and manage any potential complications. Patients may also be advised on signs and symptoms to watch for that could indicate adverse reactions or complications. The removal of the vaginal cylinder and catheters marks the end of the procedure, but ongoing monitoring and follow-up care are crucial to ensure the patient's recovery and to evaluate the need for any additional treatments.
| Short Descr | INS VAG BRACHYTX DEVICE | Medium Descr | INSERTION VAGINAL RADIATION DEVICE | Long Descr | Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 131 - Other non-OR therapeutic procedures, female organs |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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