Help please...
Scenario: 3 treatment sites for 5 fractions of SBRT each; treatment plan was made for each site (total 3 treatment plans).
Can we code 77373 x 5 for 1st site, 77373 x 5 2nd site and 77373 x 5 for 3rd site?
Additionally, CBCT was used for image guidance can we code 77014 as well
Appreciate if you can please help me out
I'm going to answer your questions separately.
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I'll start with whether Image Guidance is billable with SBRT, because that's the easy one:
Image guidance is not billable with SBRT. It's bundled into both the technical code for treatment delivery (77373) and the professional codes for treatment management (77435). You can confirm that in the CPT book, where it's specifically listed in the CPT description for both codes:
77435 - Stereotactic body radiation therapy,
treatment management, per treatment course, to 1 or more lesions,
including image guidance, entire course not to exceed 5 fractions
77373 - Stereotactic body radiation therapy,
treatment delivery, per fraction to 1 or more lesions,
including image guidance, entire course not to exceed 5 fractions
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For your other question...
SBRT stands for Stereotactic Body Radiation Therapy. It's not per lesion, it's per fraction. The description for CPT 77373 includes the possibility of treating multiple disease sites in one treatment course:
77373 - Stereotactic body radiation therapy, treatment delivery,
per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
How many treatment dates are there? If the total number of treatment fractions combined doesn't exceed 5, you'd bill one unit of CPT 77373 per fraction.
If the patient is coming in for more than 5 treatment fractions, you need to bill it as IMRT. (Regarding image guidance for IMRT: If the setting is outpatient hospital, you cannot bill the TC of 77014. It's bundled into the IMRT treatment delivery under OPPS. The PC for 77014 could be billed.)
Here are some sources for the above response:
From the Coding Guidance section of the ASTRO website:
Coding Question: If a physician has two plans for two separate lesions, but treats these on alternate days that total more than five fractions, can SBRT codes be used?
Coding Answer: Instructions for CPT code 77373 (SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions) include the possibility of treating multiple sites of disease in one treatment course. Therefore, if the sum of the treatment days for all of the sites treated during a single course of therapy exceeds five; it is not appropriate to charge CPT code 77373 for SBRT delivery.
From the ASTRO 2024 Radiation Oncology Coding Resource book:
