How To Use CPT Code 77290

CPT 77290 is a complex therapeutic radiology simulation-aided field setting code used in radiation therapy planning. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77290 procedures.

1. What is CPT 77290?

CPT 77290 is a code used to describe a complex therapeutic radiology simulation-aided field setting procedure. This procedure is essential in radiation therapy planning, as it helps physicians determine the location and size of cancerous tumors, the required radiation doses, and the positioning of radiation beams to accurately target the tumor. The complexity of this code lies in the intricate planning and customization of the therapy to maximize the impact on tumors while minimizing damage to surrounding healthy tissues.

2. 77290 CPT code description

The official description of CPT code 77290 is: “Therapeutic radiology simulation-aided field setting; complex.”

3. Procedure

The 77290 procedure involves the following steps:

1. Acquiring CT or MRI data of the patient’s tumor and surrounding area.
2. Feeding the data into a simulator to recreate the image of the tumor and its surrounding area.
3. Using the simulator, the physician determines the ports where radiation beams should enter the body to accurately target the tumor.
4. Planning and customizing the therapy to address three or more malignant regions, which may involve multiple modes of radiation therapy, complex blocking, brachytherapy, and arc therapy.
5. Designing shielding blocks to protect healthy tissues surrounding the tumor.

4. Qualifying circumstances

Patients eligible to receive CPT code 77290 services are those diagnosed with cancer and require radiation therapy as part of their treatment plan. The complexity of the tumor’s location, size, and shape, as well as the presence of three or more malignant regions, necessitates the use of a complex simulation-aided field setting procedure. Additionally, patients who require multiple modes of radiation therapy, complex blocking, brachytherapy, or arc therapy may also qualify for CPT 77290 services.

5. When to use CPT code 77290

CPT code 77290 should be used when a physician determines that a complex simulation-aided field setting is necessary for accurate radiation therapy planning. This may be due to the presence of multiple malignant regions, the need for multiple modes of radiation therapy, complex blocking, brachytherapy, or arc therapy, or the requirement for intricate planning and customization to minimize damage to surrounding healthy tissues.

6. Documentation requirements

To support a claim for CPT 77290, the following information should be documented:

• Patient’s diagnosis and medical history, including the type and stage of cancer.
• CT or MRI data used in the simulation process.
• Details of the simulation-aided field setting procedure, including the ports for radiation beam entry and the customized therapy plan.
• Justification for the use of a complex simulation-aided field setting, such as the presence of multiple malignant regions or the need for multiple modes of radiation therapy.
• Any additional treatments or procedures performed in conjunction with CPT 77290.

7. Billing guidelines

When billing for CPT code 77290, it is essential to ensure that the documentation supports the complexity of the procedure and the necessity for a complex simulation-aided field setting. Additionally, any related procedures or treatments should be billed separately, using the appropriate CPT codes. It is also crucial to follow any payer-specific guidelines and requirements for billing CPT 77290.

8. Historical information

CPT 77290 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 77290

Five similar codes to CPT 77290 and how they differ are:

• CPT 77261: This code is used for simple therapeutic radiology simulation-aided field setting, which involves less complex planning and customization.
• CPT 77262: This code is used for intermediate therapeutic radiology simulation-aided field setting, which involves a moderate level of complexity in planning and customization.
• CPT 77263: This code is used for three-dimensional therapeutic radiology simulation-aided field setting, which involves the use of 3D imaging techniques for planning and customization.
• CPT 77280: This code is used for simple therapeutic radiology localization, which involves less complex planning and customization than CPT 77290.
• CPT 77285: This code is used for intermediate therapeutic radiology localization, which involves a moderate level of complexity in planning and customization compared to CPT 77290.

10. Examples

Here are 10 detailed examples of CPT code 77290 procedures:

1. A patient with lung cancer has multiple malignant regions that require complex planning and customization of radiation therapy, including the use of tangential ports and arc therapy.
2. A patient with breast cancer requires radiation therapy targeting multiple malignant regions, necessitating the use of a complex simulation-aided field setting to minimize damage to surrounding healthy tissues.
3. A patient with prostate cancer requires brachytherapy in addition to external beam radiation therapy, necessitating the use of a complex simulation-aided field setting for accurate planning and customization.
4. A patient with head and neck cancer has a tumor with a complex geometric shape, requiring intricate planning and customization of radiation therapy using a complex simulation-aided field setting.
5. A patient with brain cancer requires radiation therapy targeting multiple malignant regions, necessitating the use of a complex simulation-aided field setting to minimize damage to surrounding healthy brain tissue.
6. A patient with cervical cancer requires radiation therapy targeting multiple malignant regions, necessitating the use of a complex simulation-aided field setting to minimize damage to surrounding healthy tissues and organs.
7. A patient with esophageal cancer has a tumor with a complex geometric shape, requiring intricate planning and customization of radiation therapy using a complex simulation-aided field setting.
8. A patient with pancreatic cancer requires radiation therapy targeting multiple malignant regions, necessitating the use of a complex simulation-aided field setting to minimize damage to surrounding healthy tissues and organs.
9. A patient with liver cancer has a tumor with a complex geometric shape, requiring intricate planning and customization of radiation therapy using a complex simulation-aided field setting.
10. A patient with bone cancer requires radiation therapy targeting multiple malignant regions, necessitating the use of a complex simulation-aided field setting to minimize damage to surrounding healthy bone tissue.