Radiology Coding Alert

ASTRO clarifies difference between port films and stereoscopic guidance

Stereoscopic x-ray guidance found its way into CPT for 2006, offering a better option than the hospital-only HCPCS code now available.

The new code is 77421 (Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy). The CPT descriptor is a little broader than the one for HCPCS code C9722 (Stereoscopic kilovolt x-ray imaging with infrared tracking for localization of target volume). Note: Code C9722 has a termination date of Dec. 31, 2005. You can find the full list of 2006 HCPCS codes on the CMS Web site at www.cms.hhs.gov/providers/pufdownload/anhcpcdl.asp.

Remember: Individual payers set their own rules about which codes they accept and reimburse. If your payer denies 77421, find out whether your payer will reimburse you for this service, what documentation it requires, and which code it prefers you to use.

Hinge Management Coding on 77421 Edit

CPT 2006 code 77421 includes the instruction not to report it with 77432 (Stereotactic radiation treatment management of cerebral lesion[s] [complete course of treatment consisting of one session]) or 0083T (Stereotactic body radiation therapy, treatment management, per day).

In its comments to the National Correct Coding Initiative, the American Society for Therapeutic Radiation and Oncology (ASTRO) reports it is working with the AMA on accurate coding for image-guided radiation therapy (IGRT), including how it relates to stereotactic radiosurgery and stereotactic radiation therapy. "Hopefully, new CPT codes will be available in 2007 for these procedures," ASTRO says. Just remember that "the process, although initiated by a specialty society, is not in any way controlled by a specialty society," says Trisha Crishock, MSW, director of ASTRO Health Care Policy and Economics.

Distinguish Port Film From Guidance X-Ray

Port films and stereoscopic guidance offer different information and therefore should not be an edited pair in National Correct Coding Initiative version 12.0, ASTRO says. Port films show the outline of the treatment field, while stereoscopic guidance x-rays are orthogonal kilovoltage images that "confirm localization of fiducial markers in the target, the target itself or soft tissue or bony anatomy" in relation to the target.