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Daily Practice

Brachytherapy

Coding Question: How do I report CPT® code 77790?

Coding Answer: CPT code 77790 is a technical component-only code, therefore there is no associated physician work. The procedure is included in the practice expense of CPT code 77778 (prostate) and cannot be co-reported, but may be billed for other codes using LDR sources if the work is performed. This can billed for use with HDR if the work is performed (gynecologic cases such as cylinder or tandem and ovoid). For details of the documentation associated with 77790 please see the brachytherapy section of the 2019 ASTRO Coding Resource.


Coding Question: What is the correct code for the use of Strontium 90 for eye treatments?

Coding Answer: The correct CPT code for surface application of radiation source is 77789. Other codes that could be billed as part of the procedure may include, but are not limited to, 77790 and 77300. All CPT codes that are billed must be medically indicated and appropriately documented.


Coding Question: How do I bill for electronic brachytherapy?

Coding Answer: Category III CPT code 0182T is a deleted code and can no longer be reported in 2016. 0182T has been replaced by CPT codes 0394T and 0395T. CPT code 0394T should be used exclusively to report HDR electronic skin surface brachytherapy treatment. CPT code 0395T should be used to report HDR electronic brachytherapy for treating sites other than skin (interstitial or intracavitary). Both CPT code 0394T and 0395T include the work of basic dosimetry calculation when performed. Therefore, CPT code 77300 should not be reported separately.

Additionally, per CPT instruction, the following services are bundled with CPT codes 0394T or 0395T: clinical treatment planning (77261–77263), basic dosimetry (77300), teletherapy isodose planning (77306–77307), brachytherapy isodose planning (77316–77318), treatment devices (77332–77334), continuing medical physics consultation (77336), treatment management (77427, 77431, 77432, 77435, 77469, 77470, 77499), intracavitary radiation (77761–77763), HDR skin surface brachytherapy (77767–77768), HDR interstitial or intracavitary brachytherapy (77770–77772), LDR brachytherapy (77778) and surface application of radiation source (77789). These codes should not be reported separately in addition to 0394T or 0395T.


Coding Question: What codes do I use to bill for intraoperative radiation therapy (IORT)?

Coding Answer: Intraoperative radiation therapy is used to treat the tumor bed at the time of surgery. Traditionally this has been delivered with electron beam cones. With the advent of new delivery methods, new technical codes have been adopted to differentiate between electron beam and photon beam treatments. In addition, an intraoperative treatment management code has been created to recognize the per session physician work involved with this modality. These codes are specifically designed to reflect IORT performed using electrons or photons and would be used once per day. IORT performed by other methods should be coded according to their respective guidelines. IORT using photons performed with electronic brachytherapy should be coded according to the respective electronic brachytherapy guidelines.

0394T- High-dose-rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry, when performed.

0395T- High-dose-rate electronic brachytherapy, interstitial or intracavitary treatment per fraction, includes basic dosimetry, when performed.
 

IORT CPT Codes:

CPT  

Description

77424

Intraoperative radiation treatment delivery, X-ray, single treatment session.

77425 

Intraoperative radiation treatment delivery, electrons, single treatment session

77469  

Intraoperative radiation treatment management

CPT codes 77424 and 77425 describe IORT treatment delivery using photons or electrons. These codes are technical-only codes and are typically reported in the facility setting. CPT code 77469 was created to describe the physician work of IORT management for either photon- or electron-based IORT treatment delivery. Similar to other radiation management codes, the IORT management code (77469) has been valued in the Medicare Physician Fee Schedule (MFPS) but is bundled and not separately paid under the Hospital Outpatient Prospective Payment System (HOPPS).

Coding Question: For HDR cases, CPT code 77300 is now included in the isodose planning codes (77316-77318). Are the subsequent decay calculations billable with additional 77300s?

Coding Answer: With the revision of the CPT codes for brachytherapy isodose planning (77316-77318) and treatment delivery (77770-77772), CPT code 77300 cannot be billed in association with these CPT codes.

Coding Question: When the radiation oncologist performs the brachytherapy procedure AND moderate (conscious) sedation can 99151-99157 be reported?

Coding Answer: The work involved in supervising conscious sedation can be reported and the code used depends on the age of the patient and time involved. The chart below details each of the codes and the specific reporting requirements.

CPT Code CPT Long Descriptor
99151 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
99153 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service)
99155 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
99156 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
99157 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service)

Coding Question: When one physician performs the external beam radiotherapy and a physician in another practice performs the brachytherapy can both report CPT code 77263 Radiation Therapy Planning, complex?

Coding Answer: Both physicians may report 77263 if the supervision of the external beam therapy is done at a separate facility or location and by a different physician than the physician performing brachytherapy.

Coding Question: When placing fiducials for gynecologic brachytherapy either post hysterectomy at the vaginal cuff or in gross tumor in patients with cervical or vaginal cancer, can CPT code 49411 be used?

Coding Answer:  Yes, CPT code 49411 is for the placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic, and/or retroperitoneum. The code is reported one time, regardless of the number of devices placed. C1879 Tissue Marker is used to capture the non-radioactive markers used in gynecologic brachytherapy. C1879 can be billed once per marker.


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®) 2015, American Medical Association. All Rights Reserved.

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