After the treatment planning is complete and the decision is made to proceed with Y-90, the dosimetry calculation will be performed. This is coded with 77300, which requires documenting patient-specifi c data to determine the total amount for administration. Per the CER Volume 5, Issue 3, Summer 2009, dosimetry involves determining the amount, rate and distribution of radiation emitted from a radiation source. According to the same CER article, a simple report or sign off by the interventional radiologist to document verifi cation, review and approval is required. As the dosimetry calculations are often performed on a separate date of service from the Y-90 mapping or Y-90 administration, it may be helpful to document the dosimetry calculations on a separate date to diff erentiate the physician work required that is unique to dosimetry calculations.
As dosimetry practices for radioembolization continue to evolve, some patients may require more tailored treatment planning with voxel-based dosimetry requiring 3D radiotherapy planning to include dose volume histograms (DVH). This additional planning occurs following the administration of Y-90 by fi rst acquiring advanced imaging and performing a fi nal calculation of the dose distribution within the liver and to surrounding nearby critical structures. The documentation of the isodose distributions and DVH with inclusion of the target and at least one critical structure from the treatment planning system would be coded with 77295.
Q When performing percutaneous endoscopic gallstone removal, when would it be appropriate to report add-
on code 47550? A Although add-on code 47550 is in the endoscopy section of the AMA CPT
Codebook, this does not imply that the code is appropriate to be used as
an add-on code to the other endoscopy codes listed thereafter, 47552–47556. Add-on code 47550 describes intraoperative biliary endoscopy and would therefore not be reported with endoscopy codes described for percutaneous approaches, 47552–47556.
When performing endoscopic gallstone removal via percutaneous access, code 47554 would be reported. 47554 represents a daughter code, instead of an add-on code, to the parent code 47552, which describes biliary endoscopy, percutaneous via T-tube or other tract. Note that if a fl uoroscopic-guided gallstone removal is performed, then this would instead be coded with add-on code 47544. Given that these procedures are performed via a percutaneous tract—and following a stone removal, a drain would again be placed—a drain exchange, such as 47536, would serve as the base code.
Therefore, if percutaneous endoscopic gallstone removal is performed via existing cholecystostomy tube access with subsequent exchange of the cholecystostomy tube at the end of the procedure, then both codes 47554 and 47536 would be reported. However, if percutaneous fl uoroscopic gallstone removal is performed via existing cholecystostomy tube access with subsequent exchange of the cholecystostomy tube at the end of the procedure, then code 47536 with add-on code 47544 would be reported.
References 1. Clinical Examples in Radiology (CER) Volume 11 Issue 3 Summer 2015
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2023/CPT®). It is not comprehensive and does not replace CPT®. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the defi nitions of the CPT® descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2023 CPT® for full and complete guidelines.
Every reasonable eff ort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, offi cers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent diff erences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fi tness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT® billing coding system lies with the user. SIR assumes no liability, legal, fi nancial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
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