Daily Practice

SRS SBRT

Coding Question: Could ASTRO give a recommendation regarding the appropriate planning codes that one may bill for SRS or SBRT treatments?

Coding Answer: For SRS and SBRT with forward planning, it is appropriate to bill CPT code 77290 for simulation, CPT code 77295 for planning, and CPT code 77373 for delivery. For SRS and SBRT with inverse planning, it is appropriate to bill CPT code 77301 for both simulation and planning, and then to bill CPT code 77373 for delivery. Please see the chart below for a summary.

CPT codes for simulation and planning IMRT planned
SRS/SBRT
3-D conformal planned SRS/SBRT Comment
77290 No Yes Work of 77290 is included in IMRT planning (77301)
77295 No Yes  
77301 Yes No  
77300 Yes Yes  
77338 Yes No  
77334 Yes Yes Immobilization (when applicable) and 3-D planned fields
77280 No Yes Verification simulation, if performed, is included in IMRT planning (77301)

Coding Question: It is my understanding that in order to treat two sites with SBRT you need to keep the treatments to five or less. If the physician has two plans and two separate lesions, but treats these on alternate days that total more than five fractions, can we bill SBRT charges?

Coding Answer: CPT instructions for CPT code 77373 (SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions) include the possibility of treating multiple sites of disease in one treatment course. Therefore, if the sum of the treatment days for all of the sites treated during a single course of therapy exceeds five; it is not appropriate to charge CPT code 77373 for SBRT delivery.

Coding Question: In the hospital setting, using a robotic modality, if a patient presents with three brain metastasis that require separate single-fraction treatment plans (related to clinical issues such as treatment time or integral dose), is it appropriate to charge the SRS treatment code (77372) and the weekly management code (77432) per treatment plan (i.e. charging 77372/77432 with each treatment delivery)? In addition, can each treatment plan (77295) be charged separately? Or should the hospital bill 77373 and the corresponding SBRT weekly management (77435) and just a single treatment plan (77295), regardless of the number of treatment plans generated and treated?

Coding Answer: If the intent is to treat three lesions separately but within the context of a single episode of care, then the appropriate codes would be 77373 for SBRT delivery, 77435 for SBRT physician management, and a single instance of 77295 for 3-D planning. If these are discrete episodes of care with separate consultation notes, separate CT scans, separate clinical treatment plans, and separate end-of-treatment notes, then 77372, 77432, and 77295 may be charged for each episode of care.

Coding Question: With the new rotating multisource Cobalt 60 system, the number of shots for a treatment may exceed 10. Each shot will include a combination of various collimators. Would you follow the rule of one device per shot not to exceed 10, or would you have a different recommendation in determining the quantity of devices to be reported?

Coding Answer: For the billing of devices, it is recommended to bill for one device per collimator per episode of care.

Coding Question: There is a CCI edit for CPT codes 77371 and 77334. Was the relative value unit (RVU) for the multisource Cobalt 60 based stereotactic radiosurgery helmet included in the SRS treatment code, or should the helmet or collimator system be reported separately?

Coding Answer: There are no CCI edits between 77371 and 77334 so these codes can be reported together. Also, there are no practice expense (PE) RVUs associated with CPT code 77371. In the Medicare Physician Fee Schedule, 77371 has been assigned a payment status indicator of “C,” which stands for carrier priced. This means the price is set by local carriers; there are no national RVUs. There are, however, PE inputs for clinical staff time and medical supplies. It would, therefore, be appropriate to report the helmet and collimator system separately.

Coding Question: How would you code the devices for the IRIS Beam Aperture Caliper (IBAC) system of robotic linear accelerator-based stereotactic radiosurgery?

Coding Answer: There are 12 separate fixed collimators, and for coding purposes the IRIS aperture is considered the equivalent of a fixed collimator. With fixed collimators, although the number performed is frequently ≤4 for SBRT, it can be done more often. You would normally charge 1x CPT code 77334 for each aperture size or fixed collimator.
 

Coding Question: Is there a situation where CPT code 77290 would apply instead of 77280 for verification simulation prior to each SBRT treatment fraction? Since the SBRT is delivered with arc therapy, the providers would like to report CPT code 77290 for "daily" verification simulation.

Coding Answer: It may be appropriate to perform a simulation prior to the first treatment session to verify immobilization, linac clearance, etc. As such, the appropriate simulation is CPT code 77280. It is not appropriate, however, to bill a daily simulation for isocenter location, as image guidance is included in the SBRT delivery codes.


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.  

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