ASTROnews: 2010 changes in radiation oncology coding

by William Noyes, M.D., M.B.A., Chair, Code Utilization and Application Committee

This article highlights the 2010 additions, deletions and revisions of some current procedural terminology (CPT) and healthcare common procedural coding system (HCPCS) codes. The codes serve as descriptions and guidelines for procedures and services performed by physicians and other healthcare providers and will help you determine the impact to your practice. A more thorough description and coding guidance on these changes can be found in the ASTRO/ACR Guide to Radiation Oncology Coding 2010, which is available at www.astro.org/shop.

2010 additions
A number of new CPT codes affecting radiation oncology became effective January 1, 2010. A new code was developed for the design and construction of a multileaf collimator (MLC) device when using IMRT, and several new interstitial device codes are now available for use.
• 77338 Multileaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction, per IMRT plan
(Do not report 77338 more than once per IMRT plan)
(For immobilization in IMRT treatment, see 77332-77334)
(Do not report 77338 in conjunction with 0073T, compensator based IMRT)

CPT Code 77338 should be reported once per treatment plan (CPT 77301).

• 31627 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) with computer-assisted, image-guided navigation
(List separately in addition to code for primary procedure[s])
(31627 includes 3D reconstruction. Do not report 31627 in conjunction with 76376, 76377)
(Use 31627 in conjunction with 31615, 31622-31631, 31635, 31636, 31638-31643)

• 32553 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple.
(Report supply of device separately)
(For imaging guidance, see 76942, 77002, 77012, 77021)
(For percutaneous placement of interstitial device[s] for intra-abdominal, intrapelvic and/or retroperitoneal radiation therapy guidance, use 49411)

• 49411 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate) and/or retroperitoneum, single or multiple
(Report supply of device separately)
(For imaging guidance, see 76942, 77002, 77012, 77021)
(For percutaneous placement of interstitial device[s] for intra-thoracic radiation therapy guidance, use 32553)

2010 revisions
A number of codes were revised to include the addition of parentheticals to provide specific coding guidance.
• An additional parenthetical regarding guidance for using code 0197T has been added to the description for Radiation Treatment Delivery set of codes (CPT codes 77401-77416).
(Radiation treatment delivery [77401-77416] recognizes the technical component and the various energy levels)
(For intra-fraction localization and tracking of target, use 0197T)

• A parenthetical has been added to the descriptor for CPT code 76950.
76950 Ultrasonic guidance for placement of radiation therapy fields
(For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876)

• The parenthetical in the descriptor for CPT code 77014 has been revised to delete “prostate.”
77014 Computed tomography guidance for placement of radiation therapy fields
(For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876)

• Code 77371 has been revised with the addition of the moderate sedation symbol (), as moderate sedation is an inherent component of this procedure. 77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of one session; multisource Cobalt-60 based

• The parenthetical in the descriptor for CPT Code 77421 has been revised to include new insertion codes and delete “prostate.”
77421 Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
(Do not report 77421 in conjunction with 77432, 77435)
(For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876)

• The descriptor for CPT Code 55876 has been revised to include percutaneous and delete “via needle, any approach.”
55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, prostate, single or multiple
This code covers transrectal placement of fiducial seeds in the prostate.

• The cross-reference following code 0182T has been updated to reflect the appropriate codes that cannot be reported with 0182T.
0182T High dose rate electronic brachytherapy, per fraction
(Do not report 0182T in conjunction with 77761-77763, 77776-77778, 77785-77787, 77789)

2009 additions
While these codes became effective in 2009, there were a few changes for 2010 as noted below.

• 77785 Remote afterloading high dose rate radionuclide brachytherapy; one channel

• 77786 2-12 channels

• 77787 over 12 channels
(Do not report 77785-77787 in conjunction with Category III Code 0182T)
These brachytherapy codes were new in 2009 and describe the provision and nomenclature of high-dose-rate brachytherapy more accurately than previous codes.

• 0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3-D positional tracking, gating, 3-D surface tracking), each fraction of treatment.

This code was released July 1, 2008, implemented January 1, 2009, and published in the CPT 2010 book.

Stereotactic radiosurgery related codes.
• 61796 Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion

• 61797 each additional cranial lesion, simple
(List separately in addition to code for primary procedure)

• 61798 one complex cranial lesion

• 61799 each additional cranial lesion, complex
(List separately in addition to code for primary procedure)

• 61800 Application of stereotactic headframe for stereotactic radiosurgery
(List separately in addition to code for primary procedure)

• 63620 Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); one spinal lesion

• 63621 each additional spinal lesion
(List separately in addition to code for primary procedure)

Coding guidance for the additions, revisions and deletions
The ASTRO/ACR Guide to Radiation Oncology Coding 2010 will be available in February 2010. The guide will contain the CMS updates for 2010 and is an essential coding reference for use in any radiation oncology practice. The guide will provide:

• 2009 and 2010 coding updates.

• Recovery Audit Contractor (RAC) program highlights.

• Updated SRS, SBRT and Brachytherapy chapters.

• New and improved FAQs for 2010.

Please visit www.astro.org/Shop to order your copy of the 2010 guide.
Dr. Noyes practices at the Cancer Center of North Dakota in Grand Forks, N.D.

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