Oncology & Hematology Coding Alert

Best beware of brachytherapy bundles.

Brachytherapy — the placement of radioactive material in or on the patient’s body to deliver a high dose of radiation to a specific, targeted area — may be a common form of cancer therapy, but it’s not easily coded. For one thing, you need to know a lot of terminology to locate an appropriate code. You also need to know what is, and what is not, included in the service, especially when the code descriptor doesn’t spell out the full scope of the procedure.

To help, here are the main dos and don’ts of brachytherapy coding.

DO Understand Delivery Methods

The first step in correctly coding brachytherapy involves knowing where the radioactive material is being delivered.

Intracavity means the provider has placed a delivery device inside a body cavity, such as a patient’s uterus, where a tumor is located or where one has just been removed. You’ll use codes 77761-77763 (Intracavity radiation source application …) for such deliveries.

Interstitial means the provider has placed a delivery device directly into the neoplasm being treated. You’ll code this kind of delivery with 77778 (Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed).

Surface means the provider has placed the delivery device on the skin. CPT^® directs you to use 77789 (Surface application of low dose rate radionuclide source) for this form of delivery.

Remote afterloading high dose rate (HDR) is used when the radioactive dosage is so high that the provider has to deliver the material remotely. When the delivery device is place on the skin, you’ll report 77767-77768 (Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed …), while you’ll use 77770-77772 (Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed …) for interstitial or intracavitary delivery device placement.

Electronically delivered HDR, because it is an emergent technology, is not assigned a code within the clinical brachytherapy codes. Instead, CPT^® assigns it temporary Category III code status and directs you to 0394T (High dose rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry, when performed) and 0395T (High dose rate electronic brachytherapy, interstitial or intracavitary treatment …).

DON’T Code These Services Together

Consult the following table and make sure you are not bundling services incorrectly.

As basic dosimetry is included in the descriptors for 77767, 77768, 77770-77772, 0394T and 0395T, you would not code 77300 (Basic radiation dosimetry calculation … as required during course of treatment, only when prescribed by the treating physician) in addition to the basic service. Dosimetry calculations and treatment planning may be reported with the intracavity (77761-77763), interstitial (77778) and surface applications (77789) procedure codes.

DO Understand Guideline Definitions

You will also need to know how many sources (intracavity or permanent interstitial placement) or ribbons (temporary interstitial placement) your provider placed. CPT^® regards one to four sources or ribbons as a simple application. An intermediate application involves five to 10 sources/ribbons, while you will code an application involving more than 10 sources/ribbons as complex. Just “be sure the documentation supports the number of sources/ribbons placed,” cautions Kristen Taylor, CPC, CHC, CHIAP, with Pinnacle Enterprise Risk Consulting Services in Columbia, SC.

Additionally, “if the provider places the afterloading apparatus for the brachytherapy, there will be an additional surgical procedure code to be billed, such as 57156 (Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy) or 58346 (Insertion of Heyman capsules for clinical brachytherapy),” says Taylor.