Radiology Coding Alert

Experts reveal whether you should charge for radiation sources separately

High dose rate (HDR) brachytherapy is becoming more popular with patients every day, which means you need to know how to apply codes 77781-77784 right the first time.
 
The codes: Four CPT codes describe remote afterloading high-intensity brachytherapy:
 
• 77781 -- Remote afterloading high-intensity brachytherapy; 1-4 source positions or catheters

• 77782 -- ... 5-8 source positions or catheters
 
• 77783 -- ... 9-12 source positions or catheters.
 
• 77784 -- ... over 12 source positions or catheters.

Break Down the Brachytherapy Code Descriptors

Our experts explain each component of codes 77781-77784, showing you the services your physician must document for you to report these codes.
 
"Remote afterloading": HDR brachytherapy uses a single high-intensity radioactive material supplied through one or more catheters by a special machine, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., president of the American Academy of Professional Coders National Advisory Board, and presenter of "Brachytherapy: Radiation From the Inside Out" at the Academy's national conference.
 
Remote afterloading refers to the radioactive material being applied by the machine after the catheter insertion.
 
"High-intensity brachytherapy": Brachytherapy involves the placement of encapsulated radioactive material, often cesium, iridium, or cobalt, in or near tumor tissue. HDR material delivers radiation at a rate of 10 cGy to 100 cGy per minute, Parman says. Low dose rate (LDR) delivers the same dose per hour.
 
HDR requires less patient treatment time and can be performed as an outpatient service, making it increasingly more popular with patients than LDR, Parman says.
 
Note: HDR treatments involve radiation sources that are used over and over for multiple patients. Payers include the cost of this sort of source in the HDR treatment codes, meaning that even if your freestanding center supplies the material, you shouldn't charge separately for it (Nov. 1, 2002, Federal Register). Hospitals may report C1717 (Brachytherapy source, high dose rate iridium 192, per source) under Outpatient PPS.
 
"Source positions or catheters": The final element of codes 77781-77784 is based on the number of source positions or catheters the oncologist uses, Parman says:
 
• 77781 -- ... 1-4 source positions or catheters
 
• 77782 -- ... 5-8 source positions or catheters
 
• 77783 -- ... 9-12 source positions or catheters
 
• 77784 -- ... over 12 source positions or catheters.

For HDR brachytherapy, a physician places small catheters in and around the tumor area. During treatment, the catheters connect to the HDR machine, which inserts the radioactive source.
 
While another physician may insert the catheters, the oncologist is the one in charge of the radioactive sources, says Becky Sweat, CPC, coder and business services coordinator with Wake Forest University Health Services in Winston-Salem, N.C.
 
Why? In most states, the radiation oncologist is specially trained to handle radioactive material, says Michael A. Ferragamo, MD, FACS, assistant clinical professor at the State University of New York, Stony Brook School of Medicine.
 
The radiation oncologist generally has a Nuclear Regulatory Commission license, as well.