Oncology Coding Article – Outpatient Prospective Payment System (OPPS)


Medical Oncology Code Changes

ACOA’s Coding Corner – December 2005

New Code for Image Guidance

There is a lot of excitement about imaging guidance, but make certain that you verify the definition before reporting this new code:

77421               Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation

·       Defines localizing target volumes in certain anatomical sites immediately prior to 3D or IMRT

·       A radiation oncologist oversees and supervises patient preparation, placement of infrared markers and the image localization procedures

·       Two sets of kV or MV X-rays are acquired to visualize internal anatomy or implanted marker positions immediately prior to treatment

·        The definition includes a combination of two kV X-ray units and two amorphous silicon flat panel detectors or an X-ray unit attached to the gantry or MV X-rays with an electronic portal imaging device (EPID) which takes two orthogonal images

·        The stereoscopic X-ray images are compared with the imported DRRs from the treatment planning system or generated DRRs from the stored CT treatment planning scan data (same plane)

·       Alignment, registration, and fusion of the two images is performed manually or automatically using implanted markers, direct visualization of the target volume, or surrounding bony anatomy

·        The rotational errors of the patient setup and the table movement necessary to optimally align the patient’s target volume at the isocenter are calculated

·       The radiation oncologist reviews the images daily, compares with previous shifts and provides feedback to the therapists

Watch for 2006 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates.

This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.

Phone: (877) 6CODING

Fax: (770) 445-0407

[email protected]

Cindy C. Parman, CPC, CPC-Hcparman-8306752
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.