New Clinical Brachytherapy Codes in 2016
Brachytherapy is a type of radiation therapy to treat cancer. A small “seed” placed in or near a lesion delivers radiation precisely, to limit radiation exposure to surrounding, healthy tissue. Radiation sources used in high-dose brachytherapy cannot be handled safely, and must be placed by remote control.
For 2016, the CPT® codebook introduced a number of new codes to describe high-dose skin surface and high-dose interstitial or intracavitary brachytherapy.
77767 Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel
77768 … lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions
CPT Changes 2016: An insider’s Guide provides the following clinical example for 77767:
A 72-year-old female presents with a 1.5 cm lesion on the nasal ala. Biopsy shows basal cell carcinoma. Definitive radiation therapy is prescribed. Simulation, computer planning, and medical physicias preparation are performed (reported separately). Surface HCR brachytherapy is then performed.
Code 77767 describes single channel afterloading of high dose rate radionuclide for skin surface brachytherapy, or for a lesion up to 2.0 cm in diameter. 77768 describes two or more channel afterloading of high dose rate radionuclide for skin surface brachytherapy of a lesion greater than 2.0 cm in diameter, or for multiple lesions. When reporting either code, basic dosimetry, if performed, is included.
77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel
77771 … 2-12 channels
77772 … over 12 channels
Code 77770 describes remote afterloading of high-dose rate radionuclide for interstitial or intracavitary brachytherapy (e.g., the radioactive seed is placed inside the body, rather than on the surface of the skin), via a single channel; 77771 describes the same procedure via 2-12 channels; and, 77772 is for more than 12 channels. In all cases, basic dosimetry, when performed, is included.
CPT Changes 2016 provides a clinical example of 77771:
A 68-year-old female presents with a 1.5 cm mammographically detected cancerous tumor in the left breast that is close to the chest wall. She undergoes lumpectomy with excision of the tumor and placement of an interstitial multichannel applicator in to the lumpectomy cavity. Sentinel node biopsies are negative for malignancy. Partial breast irradiation is prescribed. Following simulation, computer planning, and medical physics preparation (reported separately), HDR brachytherapy treatment is administered.