Oncology Coding Article - Radiopharmaceutical Therapy

When we think of radiation therapy, often our thoughts turn to external beam treatments, brachytherapy services, or advances in radiation applications such as MammoSite™, Cyber Knife™, etc. However, there is another treatment method for malignant and certain non-malignant conditions that involves the use of radiopharmaceuticals or radioactive isotopes (radioisotopes). While either a nuclear medicine specialist or radiation oncologist may perform these services, it is becoming more common for the oncology physicians to administer and monitor these agents.

Nuclear medicine uses very small amounts of radioactive materials, or radiopharmaceuticals, to diagnose and treat disease. Numerous pathological processes including, but not limited to, tumors, stress fractures, and abscesses absorb these agents. Nuclear medicine was originally termed “artificial radioactivity” and was discovered in 1934, with the first clinical use in 1937 involving the treatment of a leukemia patient. A landmark event for nuclear medicine occurred in 1946 when a thyroid cancer patient’s treatment with radioactive iodine caused a complete disappearance of the spread of the patient’s cancer. However, widespread use of nuclear medicine did not actually begin until the early 1950s. According to the Society for Nuclear Medicine (SNM), an estimated 10 to 12 million nuclear medicine imaging and therapeutic procedures are performed each year in the United States alone.

During the last decade, increased progress has been made in using radioisotopes to treat several types of cancer. Therapeutic nuclear medicine procedures may be used to treat thyroid cancer or other thyroid disorders, relieve pain from bone metastases, or treat diseases such as chronic leukemia and polycythemia vera (or polycythemia). Research programs and clinical trials are currently underway to address the effects of nuclear medicine services on rheumatoid arthritis, degenerative joint diseases, heart disease, non-small cell lung cancer, colon cancer, prostate cancer, pancreatic cancer, ovarian cancer, meningitis, AIDS and more.

79000	Radio pharmaceutical therapy, hyperthyroidism; initial, including evaluation of patient Includes both the administration of the radioisotope and the initial patient evaluation Used to treat an overactive thyroid gland; Graves Disease
79001	Radiopharmaceutical therapy, hyperthyroidism; subsequent, each therapy
79020	Radiopharmaceutical therapy, thyroid suppression (euthyroid cardiac disease), including evaluation of patient Defines the suppression (arresting the secretion) of the thyroid gland, with patient evaluation for euthyroid cardiac disease. This condition is also called thyrotoxic heart disease, and produces cardiac symptoms, signs and physiologic impairment due to over activity of the thyroid gland.
79030	Radiopharmaceutical ablation of gland for thyroid carcinoma Oral dose of iodine-131 sodium iodide to destroy the function of the thyroid gland and purposely cause hypothyroidism
79035	Radiopharmaceutical therapy for metastases of thyroid carcinoma Oral dose of iodine-131 sodium iodide to partially or fully ablate the metastatic tissues
79100	Radiopharmaceutical therapy, polycythemia vera, chronic leukemia, each treatment Intravenous injection of radiopharmaceutical to decrease overproduction of red cells
79200	Intracavitary radioactive colloid therapy Injection of radioisotope into the pleural or peritoneal cavity Usually preceded by thoracentesis or paracentesis
79300	Interstitial radioactive colloid therapy
79400	Radiopharmaceutical therapy, nonthyroid, nonhematologic May be referred to as “Strontium-89 therapy” Generally reimbursed by Medicare on for the treatment of intractable bone pain in patients with metastases from tumors producing both lytic and blastic lesions of the bone
79420	Intravascular radiopharmaceutical therapy, particulate
79440	Intra-articular radiopharmaceutical therapy
79999	Unlisted radiopharmaceutical therapeutic procedure According to the 2002 CPT Manual, the unlisted procedure code must be assigned when a code is not available to describe the exact service or procedure performed

While radiation oncologists may not separately bill the hospital admission, daily visits or discharge for brachytherapy patients, there is often no such restriction when certain nuclear medicine procedures are performed (refer to CPT code descriptors to determine which services include an initial patient evaluation). Therefore, if the radiation oncologist performs both the hospital admission and the administration of the therapeutic radiopharmaceutical, both services may be separately coded and billed, depending upon the CPT description of the service and/or local payor policy. As with all services billed to insurance, documentation must support the performance of both procedures and a modifier (such as modifier –25) may be required to establish the separate nature of the evaluation and management (E&M) service and the nuclear medicine procedure.

The facility will also submit a charge for the radiopharmaceutical itself, such as one of the following (this may not be a complete list of all agents):

A9600	Supply of therapeutic radiopharmaceutical, Strontium-89 chloride, per mCi
A9605	Supply of therapeutic radiopharmaceutical, Samarium sm153 lexidronamm, 50 mCi
C1064	Supply of radiopharmaceutical therapeutic imaging agent, sodium iodide I-131, capsule, each additional mCi (hospital only)
C1065	Supply of radiopharmaceutical therapeutic imaging agent, sodium iodide I-131, solution, each additional mCi (hospital only)
C1188	Supply of radiopharmaceutical therapeutic imaging agent, sodium iodide I-131, capsule, per initial 1-5 mCi (hospital only
C1348	Supply of radiopharmaceutical therapeutic imaging agent, sodium iodide I-131, solution, per initial 1-6 mCi (hospital only)
79900	Provision of therapeutic radiopharmaceutical(s)