How To Use CPT Code 79101

CPT 79101 describes the use of radiopharmaceutical therapy by intravenous administration to treat certain conditions. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 79101?

CPT 79101 is used to report radiopharmaceutical therapy, which involves the intravenous administration of a radioactive substance to treat specific conditions. This therapy is also known as nuclear medicine therapy and is used primarily in the treatment of cancer. The radiopharmaceutical is injected directly into a vein, allowing the radioactive material to pass through the entire body and target the affected areas.

2. Official Description

The official description of CPT code 79101 is: ‘Radiopharmaceutical therapy, by intravenous administration.’

3. Procedure

1. The provider administers a radiopharmaceutical substance intravenously to the patient.
2. The radioactive material travels through the bloodstream, targeting the affected areas.
3. The radiation emitted by the radiopharmaceutical helps to treat the patient’s condition, such as cancer.

4. Qualifying circumstances

CPT 79101 is used when radiopharmaceutical therapy is administered by intravenous administration. It should not be reported in conjunction with other specific codes, such as 36400, 36410, 79403, 96360, 96374, 96375, or 96409. For radiolabeled monoclonal antibody therapy by intravenous infusion, use code 79403. For the infusion or instillation of a non-antibody radioelement solution that includes three months of follow-up care, use code 77750.

5. When to use CPT code 79101

CPT code 79101 should be used when the provider administers radiopharmaceutical therapy by intravenous administration. It is important to ensure that the therapy is not being reported in conjunction with other specific codes mentioned above. This code is used to report the professional component of the radiopharmaceutical therapy.

6. Documentation requirements

To support a claim for CPT code 79101, the provider must document the following information:

• The specific radiopharmaceutical substance administered
• Date and time of the administration
• Medical necessity for the therapy
• Any relevant clinical findings or observations
• Signature of the provider administering the therapy

7. Billing guidelines

When billing for CPT code 79101, ensure that the therapy is being administered by intravenous administration. It is important to follow the guidelines and not report this code in conjunction with other specific codes mentioned earlier. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code. However, it is important to review payer policies as hospitals may be exempt from appending modifier TC. If the provider renders both the professional and technical components, do not append any modifiers to the code.

8. Historical information

CPT code 79101 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with thyroid cancer receiving radiopharmaceutical therapy by intravenous administration to target and treat the cancer cells.
2. A patient with bone metastases from breast cancer receiving radiopharmaceutical therapy by intravenous administration to alleviate pain and slow down the progression of the disease.
3. A patient with lymphoma receiving radiopharmaceutical therapy by intravenous administration to target and destroy the cancerous cells.
4. A patient with neuroendocrine tumors receiving radiopharmaceutical therapy by intravenous administration to target and shrink the tumors.
5. A patient with liver cancer receiving radiopharmaceutical therapy by intravenous administration to target and destroy the cancer cells in the liver.
6. A patient with prostate cancer receiving radiopharmaceutical therapy by intravenous administration to target and treat the cancer cells in the prostate gland.
7. A patient with lung cancer receiving radiopharmaceutical therapy by intravenous administration to target and destroy the cancer cells in the lungs.
8. A patient with metastatic melanoma receiving radiopharmaceutical therapy by intravenous administration to target and treat the cancer cells.
9. A patient with gastrointestinal stromal tumor receiving radiopharmaceutical therapy by intravenous administration to target and shrink the tumor.
10. A patient with head and neck cancer receiving radiopharmaceutical therapy by intravenous administration to target and treat the cancer cells in the affected area.