Radiology Coding Alert

Costly neutron delivery will have its own codes

Prepare to base your radiation reports on the specific particle beam your physician chooses--CPT Codes 2006 offers separate codes for treatment delivery depending on whether your documentation reveals protons, neutrons or electrons.

What's new: In 2005, the descriptor for code range 77412-77416 reads, "Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, special particle beam (e.g., electron or neutrons) ..."

In 2006, CPT removes neutron delivery from this code range, and the descriptor will read, "Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam ..."

The codes in the 77412-77416 range, which cover photons or electrons, still differ based on energy level (for example, CPT 77413 is for 6-10 MeV).

Study Up on Neutron Treatment Coding

The 2006 descriptor for 77412-77416 eliminates reference to neutrons because neutron delivery is now described by new codes 77422-77423:

• 77422--High-energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking

• 77423--...1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s).

Example: Your patient receives neutron therapy with wedges and custom blocking for multiple treatment areas.

2005 way: Report a code from the 77412-77416 range for services before Jan. 1, 2006, says Pamela Moore, CPC, patient representative at Moll Cancer Center in Cleveland.

2006 way: Report 77423 for services performed on or after Jan. 1, 2006.

Bottom line: Neutron therapy, which requires very expensive equipment, will have its own set of codes (77422-77423), just like proton treatment delivery (77520-77525), Moore says.
 
You should still use 77412-77416 for electron treatment, and you should choose the code based on the energy level used for treatment. Note: You may also use this code range for photon treatment.

Nip NCCI-Based Denials in the Bud

After analyzing the proposed National Correct Coding Initiative edits for the new neutron codes, scheduled for Jan. 1, 2006, the American Society for Therapeutic Radiation and Oncology (ASTRO) recommended a few changes. Find the comments at www.astro.org/pdf/HealthCare/coding/030205cci120.pdf, says Trisha Crishock, MSW, director of ASTRO Health Care Policy and Economics.

1. Neutron and regular treatment delivery codes: NCCI wants to limit your ability to report regular treatment delivery codes 77401-77416 with the new neutron codes, 77422-77423. ASTRO offered scenarios in which a patient with a salivary gland tumor would require both neutron and electron treatments on the same day.

Example: A patient presents with a salivary gland tumor that has metastasized to the bones. The radiation oncologist may use neutrons to treat the bulk tumor but choose electrons to treat rib metastases in an effort to protect the lung.

2. Neutrons with IV fluids and/or drug therapy: ASTRO objected to forbidding these two services on the same claim, stating that neutron-therapy patients may require IV hydration.

Example: The radiation oncologist prescribes IV hydration (such as CPT 2006 code 90760, Intravenous infusion, hydration; initial, up to 1 hour) for a patient whose throat pain and inability to swallow lead to dehydration on the day of treatment.

ASTRO also wants to keep the option of coding neutron treatment with chemotherapy, although oncologists don't use these treatments together now because of toxicity. Why: The future may hold new agents that don't present the same problems.