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 be 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 chapter 19 of the 2023 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Coding Answer: Category III CPT code 0182T is a deleted code and can no longer be reported in 2016. 0182T has been replaced by CPT codes 0394T and 0395T.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. Please review Chapter 19 in the 2023 ASTRO Coding Resource for more information about electronic brachytherapy.
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.
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 and includes the work described by 77290, 77334, 77431, and 77470. 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.
Coding Question: Can you charge 77295 for HDR boost planning after external beam radiation therapy with IMRT?
Coding Answer: If external beam or teletherapy is combined with brachytherapy an external beam isodose plan is performed and the appropriate code should be reported using CPT codes 77295, 77301, 77306 or 77307, depending on the type of isodose plan created. If a patient subsequently undergoes brachytherapy during the same course of therapy the appropriate isodose plan to report is typically from CPT codes 77316-77318. However, CPT code 77295 (3-D planning) can be used for volume implant dosimetry for brachytherapy that rises to the level of a 3-D isodose plan in addition to the external beam 3-D isodose plan, if performed. Please see Chapter 19 in the 2023 ASTRO Coding Resource for additional information.
Coding Question: Previous guidance has been that only one instance of CPT 77295 (3-D radiotherapy plan) can be reported per clinical course of treatment. For Brachytherapy, is it permissible to report CPT 77295 more than once per course of treatment?
Coding Answer: Yes, if the medically necessary work rises to the level of a 3-D plan, CPT® 77295 may be reported for each brachytherapy fraction. This work includes acquisition of a volumetric CT scan and/or MRI while the patient is in the exact position he/she will be in for the actual radiation treatments. The radiation oncologist contours the target volume and critical normal structures which are reconstructed for three-dimensional visualization. The radiation oncologist, in collaboration with a qualified medical physicist or dosimetrist, optimizes dose coverage of the target and avoidance of organs at risk. The dose distribution is analyzed using a dose volume histogram. The nature of Brachytherapy procedures, including change in tumor volume and changes in source/applicator position and geometry from fraction to fraction may require additional 77295 procedures on subsequent dates of service. Guidance related to this code has always recognized that changes in patient anatomy or tumor volume may necessitate additional instances of 77295 subsequent to the initial procedure.
