How To Use CPT Code 77386

CPT 77386 refers to the complex intensity modulated radiation treatment delivery (IMRT) procedure, which includes guidance and tracking when performed. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77386.

1. What is CPT 77386?

CPT 77386 is a code used to describe the complex intensity modulated radiation treatment delivery (IMRT) procedure. IMRT is a type of radiation therapy that delivers precise, high-intensity radiation doses to malignant tumors or specific areas within the tumor while minimizing the dose to surrounding normal tissues. This code is used when the provider performs the IMRT procedure, which includes guidance and tracking when performed.

2. 77386 CPT code description

The official description of CPT code 77386 is: “Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex.”

3. Procedure

The 77386 procedure involves the following steps:

1. Identification of the tumor using imaging guidance, primarily computed tomography (CT) or magnetic resonance imaging (MRI).
2. Determination of the treatment delivery based on tumor shape, CT images, and computerized dose calculations.
3. Use of a medical linear accelerator and multileaf collimator (MLC) to deliver the optimal dose of radiation to the targeted area.
4. Control of the radiation beam to ensure the cumulative radiation dose remains within acceptable limits for surrounding normal tissues.
5. Monitoring and tracking of the radiation delivery using guidance and tracking systems when performed.

4. Qualifying circumstances

Patients eligible to receive CPT code 77386 services are those diagnosed with cancer and require complex IMRT treatment. This includes patients with tumors that have irregular shapes, are located near critical structures, or require a high degree of precision in radiation delivery to minimize damage to surrounding healthy tissues. The provider must determine that IMRT is the most appropriate treatment option for the patient based on their specific clinical circumstances.

5. When to use CPT code 77386

CPT code 77386 should be used when the provider performs a complex IMRT procedure, which includes guidance and tracking when performed. This code is appropriate for cases where the patient requires a high degree of precision in radiation delivery due to the tumor’s location, shape, or proximity to critical structures. The provider must determine that IMRT is the most suitable treatment option for the patient based on their specific clinical circumstances.

6. Documentation requirements

To support a claim for CPT 77386, the following information should be documented:

• Patient’s diagnosis and medical history, including the type and stage of cancer.
• Indication for the use of IMRT, including the rationale for selecting this treatment modality over other options.
• Details of the treatment planning process, including tumor identification, dose calculations, and radiation beam control.
• Information on the guidance and tracking systems used during the procedure, if applicable.
• Documentation of the treatment delivery, including the number of treatment sessions and the total radiation dose delivered.
• Any relevant follow-up care or monitoring required after the IMRT procedure.

7. Billing guidelines

When billing for CPT code 77386, it is important to follow the appropriate guidelines and rules. This code includes the technical component of image guidance and tracking, so the modifier TC should not be added when reporting this code. The professional component can be reported using the 26 modifier for guidance and tracking when reporting this code. Do not report CPT codes 77385, 77386 in conjunction with 77371, 77372, or 77373.

8. Historical information

CPT 77386 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to this code since its addition.

9. Similar codes to CPT 77386

Five similar codes to CPT 77386 and how they differentiate are:

• CPT 77385: This code describes simple IMRT treatment delivery, which includes guidance and tracking when performed, but does not involve the same level of complexity as CPT 77386.
• CPT 77371: This code refers to stereotactic body radiation therapy (SBRT) treatment management, which is a different type of radiation therapy that delivers high doses of radiation to small, well-defined tumors.
• CPT 77372: This code is used for SBRT treatment delivery, which is a different type of radiation therapy than IMRT.
• CPT 77373: This code describes SBRT treatment delivery using robotic linear accelerator-based systems, which is a different type of radiation therapy than IMRT.
• CPT 77387: This code is used to report the professional component of guidance and tracking for IMRT when used with modifier 26.

10. Examples

Here are 10 detailed examples of CPT code 77386 procedures:

1. A patient with a brain tumor located near critical structures requires complex IMRT to minimize damage to surrounding healthy tissues.
2. A patient with prostate cancer requires complex IMRT due to the irregular shape of the tumor and proximity to critical structures.
3. A patient with lung cancer requires complex IMRT to deliver a high dose of radiation to the tumor while minimizing the dose to surrounding normal tissues.
4. A patient with head and neck cancer requires complex IMRT to target multiple tumor sites while minimizing the dose to surrounding normal tissues.
5. A patient with breast cancer requires complex IMRT to deliver a high dose of radiation to the tumor while minimizing the dose to the heart and lungs.
6. A patient with pancreatic cancer requires complex IMRT to target the tumor while minimizing the dose to surrounding normal tissues and critical structures.
7. A patient with cervical cancer requires complex IMRT to deliver a high dose of radiation to the tumor while minimizing the dose to surrounding normal tissues.
8. A patient with liver cancer requires complex IMRT to target the tumor while minimizing the dose to surrounding normal tissues and critical structures.
9. A patient with esophageal cancer requires complex IMRT to deliver a high dose of radiation to the tumor while minimizing the dose to surrounding normal tissues.
10. A patient with rectal cancer requires complex IMRT to target the tumor while minimizing the dose to surrounding normal tissues and critical structures.