How To Use CPT Code 49412

CPT 49412 describes the placement of interstitial device(s) for radiation therapy guidance in the intra-abdominal, intrapelvic, and/or retroperitoneal regions. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49412?

CPT 49412 is used to describe the placement of interstitial device(s) for radiation therapy guidance in the intra-abdominal, intrapelvic, and/or retroperitoneal regions. This code is used when a provider inserts fiducial markers or a dosimeter to aid in the delivery of radiation therapy to targeted soft tissue. The procedure is performed concurrently with another open abdominal, pelvic, or retroperitoneal procedure, such as tumor removal.

2. Official Description

The official description of CPT code 49412 is: ‘Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure)’

Notes: (Use 49412 in conjunction with open abdominal, pelvic, or retroperitoneal procedure[s] performed concurrently) (For placement of interstitial device[s] for intra-abdominal, intrapelvic, and/or retroperitoneal radiation therapy guidance concurrent with laparoscopic procedure, use 49327 ) (For percutaneous placement of interstitial device[s] for intra-abdominal, intrapelvic, and/or retroperitoneal radiation therapy guidance, use 49411 )

3. Procedure

1. The provider performs another primary procedure, such as tumor removal, in the intra-abdominal, intrapelvic, or retroperitoneal region.
2. While performing the primary procedure, the provider places fiducial markers or a dosimeter in the interstitial space of the targeted soft tissue.
3. The provider uses palpation or imaging guidance to place the fiducial markers or dosimeter around the tumor site.
4. If necessary, the provider repeats the placement procedure until an adequate number of fiducial markers or dosimeters are in place.
5. After achieving hemostasis, the provider removes all instruments and closes the wound in layers.

4. Qualifying circumstances

CPT 49412 is performed in conjunction with another open abdominal, pelvic, or retroperitoneal procedure. The placement of interstitial device(s) is necessary to guide radiation therapy for targeted soft tissue. The procedure is typically performed when the patient has a tumor or disease in the intra-abdominal, intrapelvic, or retroperitoneal region that requires radiation therapy. The provider must use image guidance, if performed, during the placement procedure.

5. When to use CPT code 49412

CPT code 49412 should be used when a provider performs the placement of interstitial device(s) for radiation therapy guidance in the intra-abdominal, intrapelvic, and/or retroperitoneal regions. This code should only be reported when the placement procedure is performed concurrently with another open abdominal, pelvic, or retroperitoneal procedure. If the placement procedure is performed laparoscopically, use CPT code 49327. For percutaneous placement, use CPT code 49411.

6. Documentation requirements

To support a claim for CPT 49412, the provider must document the following information:

• Primary procedure performed concurrently with the placement of interstitial device(s)
• Specific details of the placement procedure, including the number of fiducial markers or dosimeters placed
• Use of image guidance, if performed
• Date and duration of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 49412, ensure that the placement procedure is performed concurrently with another open abdominal, pelvic, or retroperitoneal procedure. This code should not be reported as a standalone code. It is important to bill the primary CPT code first, and then list CPT 49412 separately. Additionally, the provider may bill for the fiducial marker supply separately. It is important to review coding edits and guidelines to ensure accurate reporting of CPT 49412.

8. Historical information

CPT 49412 was added to the Current Procedural Terminology system on January 1, 2011. It was later added to the Inpatient Only (IPO) list for Medicare in 2017. There have been no other updates or changes to the code since its addition.

9. Examples

1. A provider performs a tumor removal procedure in the intra-abdominal region and concurrently places fiducial markers for radiation therapy guidance.
2. During an open pelvic procedure, a provider places dosimeters to aid in the delivery of radiation therapy to targeted soft tissue.
3. While performing a retroperitoneal procedure, a provider inserts fiducial markers to guide radiation therapy for a tumor.
4. A patient undergoes an intra-abdominal procedure for tumor excision, and the provider places fiducial markers to assist in radiation therapy targeting.
5. During a pelvic surgery, a provider inserts dosimeters to measure radiation exposure in the targeted soft tissue.
6. A provider performs a retroperitoneal procedure and concurrently places fiducial markers for radiation therapy guidance.
7. While removing a tumor in the intra-abdominal region, a provider inserts dosimeters to monitor radiation dosage.