Oncology & Hematology Coding Alert

Tip: Limit code 77387 to the technical component of all imaging guidance.

In the last issue of Radiology Coding Alert Vol18n9, you attempted a quiz for radiation therapy. Here are answers to the quiz with guidance from experts to help you assess your understanding of radiation therapy coding.

Answer 1: The correct answer is c, 77407.

The code 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day) refers to a superficial treatment unit, sometimes known as ortho voltage, which physicians may use on skin lesions.

For simple, intermediate, and complex radiation therapy, you have codes 77402 (Radiation treatment delivery, ≥1 MeV; simple), 77407 (Radiation treatment delivery, ≥1 MeV; intermediate), and 77412 (Radiation treatment delivery, ≥1 MeV; complex), respectively.

You submit code 77402 when the treatment involves a single treatment area, one or two ports, and zero, one or two simple blocks. For treatment involving two different treatment areas, each with three or more ports aimed at the area, and three or more blocks, you turn to code 77407. Code 77412 is for treatment in three or more treatment areas with specialized blocking tailored to the individual treatment. It may involve variations in types of ports and angles or delivery, and changes in the energy beam itself.

Answer 2: The correct answer is d, one unit reported for each lesion treated.

The 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) applies to the technical component of stereotactic body radiation therapy.

Your physician will use a three–dimensional coordinate system to locate small targets or lesions inside the body and destroys them with precision using externally generated ionized radiation.

Number of fractions: The code 77373 covers a single fraction of a course of up to five fractions.

Answer 3: The correct answer is b, 77387.

The code 77387 (Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed) applies to radiological guidance for delivery of radiation therapy.

Code 77373 is for stereotactic radiation therapy. Codes 77407 and 77412 are for intermediate and complex radiation treatment, respectively.

Answer 4: The correct answer is option d, 77424.

The code 77424 (Intraoperative radiation treatment delivery, x-ray, single treatment session) implies the technical component of a procedure in which your provider administers radiation therapy in the form of irradiating X–rays directly to the exposed tumor during surgery. When your provider administers irradiating electron beam directly to the exposed tumor during surgery, you submit code 77425 (Intraoperative radiation treatment delivery, electrons, single treatment session).

Answer 5: The correct answer is option b, 77014.

For placement of radiation therapy field with CT guidance, you submit code 77014 (Computed tomography guidance for placement of radiation therapy fields). Code 77387 is for technical component of imaging guidance for the volume of radiation required for treatment. Code 77417 (Therapeutic radiology port image[s]) is for port images.

Kristen Taylor, Managing Director; Pinnacle Enterprise Risk Consulting Services, LLC offers the following advice:

"CPT^® 77387 was created in 2015 to replace the individual guidance codes:

• 76950 (Ultrasonic guidance for placement of radiation therapy fields),
• 77421 (Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy),
• 0197T (Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3d positional tracking, gating, 3d surface tracking), each fraction of treatment), and
• 77014 (Computed tomography guidance for placement of radiation therapy fields).

Codes 76950, 77421 and 0197T were deleted. However, 77014 was not.

Hospitals report code 77387 for the technical component of all imaging guidance. Code 77014 is only reported for the technical component of CT guidance in the office setting and the professional component in the hospital and office setting. Three new G-codes were developed to replace the other imaging codes. Below is a table to assist you in selecting the correct imaging codes."

Table: Image Guidance Codes

You can read more on: http://www.acr.org/~/media/ACR/Documents/PDF/News/Complex 2015 Changes to Radiation Oncology Coding.pdf.