Coding Question:

A member requests clarification of the CPT code 77470. A facility recently had consultants review their radiation therapy billing. The consultants suggested that the facility bill more frequently for 77470. Their reasoning was based on the ASTRO/ACR Radiation Oncology Coding User's Guide 2002. They explained that there is always additional work by the physician for IMRT, HDR, Brachytherapy, etc. The member contacted the Medical Director at Empire Medical Services in New York . He and his support team explained that 77470 is reserved for use when the physician expends more work and effort in addition to the expected work and effort for the services mentioned. This would be a clinical judgment made by the physician, who would of course have appropriate documentation as well. They do not expect this code to be used frequently. However, another consultant said that “77470 should always be billed with 77263; should always bill for 77470 with IMRT, HDR, Brachytherapy, concurrent chemotherapy, 3D-CRT and any other special time-consuming and complex treatment planning." Who or what defines "special time-consuming and complex treatment planning"?

CUAC Response:

The ASTRO/ACR Guide To Radiation Oncology Coding 2005 states that CPT code 77470; Special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation), should be reported only once per course of therapy. Further, special treatment procedure covers the additional physician effort and work for such procedures as total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation (per oral, endocavitary or intraoperative). This code may also be reported in other clinical situations as determined by the radiation oncologist to recognize the added physician and facility work that accompanies the management of certain clinical situations (i.e., concurrent chemotherapy) or highly complex technical scenarios (i.e., IMRT, 3D-CRT, brachytherapy, etc.). This code should not be linked with CPT code 77263; Therapeutic radiology treatment planning; complex, or billed routinely with every 3D-CRT, rather it should be defined by the complexity and the effort involved in the specific clinical situation (i.e., if extra effort is required in pediatric cases – even if the planning is 2-D or simple – this code may be justified). This code is not intended to be used because a patient has another, ongoing medical diagnosis such as diabetes, COPD or hypertension. Written documentation supporting the extra work is required for this CPT code.

The opinions referenced are those of members of the ASTRO Code Utilization and Application Committee (CUAC) 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

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