Q&A: CPT coding for the management of time-consuming radiation procedures
Q: When is it appropriate to bill CPT code 77470 (special treatment procedure [e.g. total body irradiation, hemibody radiation, per oral or endocavitary irradiation]) for a special treatment procedure?
A: CPT code 77470 describes treatment management for radiation procedures that require extensive planning. This code was first introduced in the 1970s to ensure proper reimbursement for time-consuming treatment management.
Code 77470 is usually reported with other radiation treatment management codes, such as:
- 77427, radiation treatment management, five treatments
- 77431, radiation therapy management with complete course of therapy, consisting of one or two fractions only
- 77432, stereotactic radiation treatment management of cranial lesion(s), (complete course of treatment consisting of one session)
- 77499, unlisted procedure, therapeutic radiology treatment management
It is not intended to be used because a patient suffers from an ongoing medical diagnosis such as diabetes or hypertension.
Per Medicare’s Billing and Coding Guidelines for Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT), this code is used to cover the additional physician effort and work required for:
- 3D CRT
- Any other special time-consuming treatment plan
- Brachytherapy
- Heavy particles (e.g. protons/neutrons)
- Hyperfractionation
- Hyperthermia
- IMRT
- Intracavitary cone use
- Intra-operative radiation therapy and hemibody irradiation
- Planned combination with chemotherapy or another combined modality therapy
- Radiation response modifiers
- Stereotactic radiosurgery
- Total body irradiation
This code may be used when a physician administers concurrent chemotherapy with radiation therapy. It may also be used to provide reimbursement for the time and effort associated with anesthesia administration for various radiation treatments or simulations.
Another example is for the treatment of total body cases with radiation therapy. Total body irradiation (TBI) gives a dose of radiation to the entire body and is often performed prior to a bone marrow transplant. TBI requires an extensive amount of planning to ensure the proper dose and avoid damage to major organs; therefore, Medicare allows providers to bill code 77470 with planning, simulation, and radiation treatment codes.
Coders should note that 77470 is a one-time billable code, meaning it can be reported once per course of radiation therapy. This code should never be used on a routine basis, and provider documentation must provide a rationale for its application.
Editor’s note: Susan Vannoni, ROCC, CEO and founder of Radiation Oncology Consulting in Phoenix, Arizona, answered this question. Vannoni performs audits of radiation oncology charge capture nationwide, reviewing billing practices and procedures as well as the documentation process.
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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