Oncology & Hematology Coding Alert

Question: Our practice recently started providing eye treatment using Strontium 90. Which codes should I report for the physician's services?

California Subscriber

Answer: Strontium 90 treatment for the eye involves surface application of the radiation source, so the code for treatment is 77789 (Surface application of radiation source).

If you're reporting only the physician's services, be sure to append modifier 26 (Professional component) to this code, which the Medicare physician fee schedule indicates has both professional and technical components.

Helpful: The coding subcommittee for the American Society for Radiation Oncology (ASTRO) indicates that other codes that may apply for this service include the following:

• 77790 -- Supervision, handling, loading of radiation source
• 77300 -- Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician.

These codes also have both professional and technical components, so you should again append modifier 26 to report the physician's services only.

You can access the ASTRO Q&A at www.astro.org/HealthPolicy/RadiationOncologyCoding/CodingFAQ/Brachytherapy/index.aspx.

Procedure: Radiation oncologists may treat a patient's eye following surgery for a pterygium. After the surgeon removes this potentially vision impairing thickening of the conjunctiva (the thin membrane covering the white part of the eye and the inner eyelid), the radiation oncologist administers radiation. Treatment is performed during the healing period to prevent the pterygium from growing back. The radiation oncologist uses a strontium beta irradiation applicator, placing it on the surface of the eye and delivering a low dose of radiation to the surgically treated area.