Oncology & Hematology Coding Alert

Question: What is the proper CPT code for image fusion when the patient has stereotactic radiosurgery?

South Carolina Subscriber

Answer: To bill image fusion, you-ll have to use unlisted code 77399 (Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services).

Reason: CPT guidelines state, -Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code.-

Because there is no current CPT code that accurately describes image fusion, you must use an unlisted code. Include a description in box 19 of the claim form and expect a request for records from the payer.

As with any unlisted procedure code claim, getting paid may be a challenge. And the reality is many payers consider fusion to be a part of planning and won't reimburse it separately.

But you can put your best foot forward with a detailed report describing the procedure and the time, skill, and equipment required. Peer-reviewed clinical articles supporting the service and information showing how the service saved money over other options can also help support your claims. For reimbursement, compare the service provided to an existing code that involves similar work.