Coding Q&A By Christina G. Marks, MD
Coding for radioembolization of hepatic tumors
radioembolization of hepatic tumor(s) and also acts as the authorized user (AU) for the procedure, what documentation requirements are necessary to code for 77263, 77300 and 77295?
Q When an interventional radiologist performs a A Currently, there are no specific documentation requirements for radioembolization regarding these three codes.
For interventional radiologists acting as authorized users for radioembolization, 77263 describes the treatment planning process, 77925 describes 3D radiotherapy planning and 77300 describes the dosimetry calculation. Therefore, 77263 and 77925 would be completed prior to 77300.
Clinical treatment planning codes are defined as simple (77261), intermediate (77262) and complex (77263). According to the 2025 CPT Professional, these codes include interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, and selection of appropriate treatment devices. Complex treatment planning is defined as highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotation, or special beam considerations combination of therapeutic modalities.
Per recent SIR guidelines on coding for radioembolization procedures, clinical treatment planning usually includes interpretation of available advanced imaging studies, tumor localization, treatment volume determination, treatment time and dosage determination, choice of treatment modality, and selection of appropriate treatment devices. These same guidelines suggest that documentation to support coding for 77263 include both indications and goals of the proposed treatment plan as well as a description of the dose prescription parameters, such as the specific dose constraints for the target(s) and nearby critical structures. Information on embolization of normal liver arterial supply to avoid normal liver radiation from a proximal treatment position, use of two microcatheters at two different positions to reduce normal liver radiation exposure, or coiling adjacent non-target arterial branches can be included.
Just as each patient treated will have different tumor location and volume, so will each patient have different prior imaging studies to review (such as CT, MRI or prior angiography), prior surgical history, prior radioembolization procedures, etc. Therefore, inclusion of specific information to justify coding 77263 will be patient- specific and could include work performed separate from an initial patient visit (E&M) encounter, such as prior angiographic studies, cross-sectional imaging, previous treatment, the Tc99m-MAA scan and 3D reconstructed imaging to plan the Y-90 delivery.1
As the treatment planning is often performed on a separate date of service
from the initial E&M, it may be helpful, but not required, to document the treatment planning on a separate date to differentiate the physician work required that is unique to treatment planning.
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Per recent SIR guidelines on coding for radioembolization procedures, clinical treatment planning usually includes interpretation of available advanced imaging studies, tumor localization, treatment volume determination, treatment time and dosage determination, choice of treatment modality, and selection of appropriate treatment devices.
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