SRS and SBRT
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 response: 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 Response: 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.
CPT code 77371: Srs multisource
CPT code 77334: Radiation treatment aid(s)
Coding Question:How would you code the devices for the IRIS Beam Aperture Caliper (IBAC) system of robotic linear accelerator-based stereotactic radiosurgery?
Coding Response: 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.
CPT code 77334: Radiation treatment aid(s)
Coding Question: What are the correct code(s) for a freestanding facility to use to bill for the technical component of image guided robotic linear accelerator-based stereotactic radiosurgery? From our reading we thought it was CPT code 77373. The free-standing facility staff thinks it should be G0339 and G0340 because "robotic" is referenced in the G codes.
Coding Response: HCPCS codes such as G0339 that are used by hospitals are not recommended for reporting or billing in a free-standing facility. CPT codes 77372 (1fraction) and 77373 (2-5 fractions) should be billed by free-standing facilities. It should be noted that HCPCS codes G0339 and G0340 may be carrier priced in the free-standing facility in some states. The active CPT codes for single fraction and fractionated SBRT are 77372 and 77373.
CPT code 77372: Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based
CPT code 77373: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
HCPCS code G0339: Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
HCPCS code G0340: Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment.
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. Should this service instead be reported with the standard 77280 verification service? We wanted to verify current coding methods for this situation because this is a newer technology.
Coding Response: 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.
CPT code 77280: Therapeutic radiology simulation-aided field setting; simple
CPT code 77290: Therapeutic radiology simulation-aided field setting; complex
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®) 2012, American Medical Association. All Rights Reserved.
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