Radiology Coding Alert

A novel application for a conventional cancer treatment is being adopted throughout the country and in some areas being reimbursed by Medicare and commercial payers.

Brachytherapy in which a source of radiation is placed next to or inside an affected body part is commonly used to treat some types of cancer (e.g., prostate). Late in 2000, the Food and Drug Administration approved a device that allows this treatment to be used with patients suffering from coronary artery disease (CAD), who are at risk for restenosis of arteries treated with balloon angioplasty or stent placement. Early clinical studies, however, have not produced definitive results about the effectiveness of this modality.

Intravascular brachytherapy is an innovative approach and is viewed in some circles as one of the more promising treatment options, says Lynn C. Esposito, CPC, clinical practice specialist with Hunter Radiation Therapy at the Yale University School of Medicine. Although ultimately not used, intravascular brachytherapy was reportedly one of the treatment modalities recently considered to treat Vice President Dick Cheneys cardiac episode.

Intravascular brachytherapy is performed typically by both a cardiologist and radiation oncologist, although some interventional radiologists (I/R) are also performing the procedure and assume the role otherwise undertaken by the cardiologist. The cardiologist or I/R performs the angioplasty and places the catheter. The radiation oncologist, who holds the Nuclear Regulatory Commission licensure to handle the source, assists in placing the radioactive seeds.

Esposito points out that there are no specific procedure codes for this service, although the American College of Cardiology (ACC) has applied to CPT Codes for new ones, which will potentially be in the Cardiovascular section of the CPT Manual . The absence of codes has resulted in three disparate approaches to reporting intravascular brachytherapy appropriately:

1. Some radiation oncology coding experts strongly recommend using CPT 77799 (unlisted procedure, clinical brachytherapy) to cover the entire procedure, arguing that other coding scenarios represent inappropriate upcoding.

2. Other practices, like Espositos, have followed the advice of professional organizations like the American Society of Therapeutic Radiology and Oncology (ASTRO) and are assigning a series of related radiation oncology codes to describe each step of the service. (The explanation that follows reflects ASTROs recommendations.)

3. Still others agree with the use of radiation oncology codes up to the point of assigning them for the treatment portion of the service, but then recommend assigning the unlisted procedure code for that final component (Step 4 below).

Because of these diverse approaches, practices should work closely with payers to determine what is acceptable in their area.

Coders Hopeful of Reimbursement

Although brachytherapy is approved by the FDA, many coders anticipate claim denials because the ICD-9 codes supporting medical necessity for [...]