Oncology Coding Article – Outpatient Prospective Payment System (OPPS)


Medical Oncology Code Changes

ACOA’s Coding Corner – January 2006

New Code for Image Guidance (continued from December 2005)

Effective January 1, 2006, there is a new code for x-ray guidance for localization, but make certain that it is reported correctly!

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

This code is used to describe target volume localization in certain anatomic areas prior to 3D or IMRT treatment delivery.  Code 77421 includes locating the target on orthogonal x-rays with or without fiducial markers. According to official AMA definitions:

o        The radiation oncologist oversees patient preparation.

o        Two (2) sets of x-rays are acquired, using kV or MV x-rays units.  This may include 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 that takes two orthogonal images.

o        The acquired images are compared with imported digital reconstructed radiographs (DRRs) from the treatment planning system, or generated DRRs from the stored CT treatment planning data (same plane as the x-rays acquired).

o        Code 77421 includes the alignment, registration and fusion of the images, either manually or automatically, under the supervision of the radiation oncologist.

o        Any deviations noted are corrected by adjusting patient treatment position, under the supervision of the radiation oncologist.

o        The radiation oncologist reviews the images daily and compares with previous shifts.

o        The physician provides feedback to the therapists regarding adequacy of registrations and treatment modifications.

o        In addition, this service is not reported with either SRS or SBRT treatments.

Watch for more 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-2938197
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.