How To Use CPT Code 79200

CPT 79200 describes the procedure of radiopharmaceutical therapy, specifically by intracavitary administration. 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 79200?

CPT 79200 can be used to describe a therapeutic nuclear medicine procedure known as radiopharmaceutical therapy. This procedure involves the placement of a radiopharmaceutical substance directly into a body cavity or space, such as the uterus. The purpose of this therapy is to treat certain conditions, particularly cancer, by delivering radiation directly to the affected area.

2. Official Description

The official description of CPT code 79200 is: ‘Radiopharmaceutical therapy, by intracavitary administration.’

3. Procedure

1. In this procedure, a qualified healthcare provider places a radiopharmaceutical substance directly into a body cavity or space.
2. The radiopharmaceutical substance is held in place by an applicator, ensuring that it remains in the desired location.
3. The healthcare provider then irradiates the tumor area with radiation using the applicator, aiming to minimize damage to non-involved organs or nearby structures.
4. Once the radiotherapy session is complete, the healthcare provider withdraws the applicator from the body cavity or space.

4. Qualifying circumstances

Radiopharmaceutical therapy is typically used to treat conditions such as cancer. It is important to note that this procedure should only be performed by a qualified healthcare provider who has the necessary expertise and training in nuclear medicine therapy. The use of radiopharmaceuticals requires careful consideration of the patient’s condition and the potential risks and benefits of the treatment.

5. When to use CPT code 79200

CPT code 79200 should be used when a healthcare provider performs radiopharmaceutical therapy by intracavitary administration. This code is specific to the procedure described and should not be used for other types of nuclear medicine therapy or radiation treatments.

6. Documentation requirements

To support a claim for CPT 79200, the healthcare provider must document the following information:

• Patient’s diagnosis and the medical necessity of radiopharmaceutical therapy
• Details of the radiopharmaceutical substance used and its administration
• Date and duration of the procedure
• Specific body cavity or space where the radiopharmaceutical substance was placed
• Any additional relevant information or observations made during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 79200, ensure that the procedure is performed by a qualified healthcare provider and that it involves the intracavitary administration of a radiopharmaceutical substance. It is important to follow payer guidelines and any applicable modifiers when reporting this code. Additionally, consider the need for separate reporting of the radiopharmaceutical substance itself, as it may be billed separately.

8. Historical information

CPT 79200 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A qualified healthcare provider performs radiopharmaceutical therapy by intracavitary administration to treat a patient with uterine cancer.
2. During the procedure, the healthcare provider places a radiopharmaceutical substance directly into the patient’s bladder to treat bladder cancer.
3. A patient with lung cancer undergoes radiopharmaceutical therapy by intracavitary administration, with the radiopharmaceutical substance placed directly into the pleural cavity.
4. A healthcare provider performs radiopharmaceutical therapy by intracavitary administration to treat a patient with cervical cancer.
5. During the procedure, the healthcare provider places a radiopharmaceutical substance directly into the patient’s esophagus to treat esophageal cancer.
6. A qualified healthcare provider performs radiopharmaceutical therapy by intracavitary administration to treat a patient with ovarian cancer.
7. During the procedure, the healthcare provider places a radiopharmaceutical substance directly into the patient’s rectum to treat rectal cancer.
8. A patient with brain cancer undergoes radiopharmaceutical therapy by intracavitary administration, with the radiopharmaceutical substance placed directly into the tumor cavity.
9. A healthcare provider performs radiopharmaceutical therapy by intracavitary administration to treat a patient with breast cancer.
10. During the procedure, the healthcare provider places a radiopharmaceutical substance directly into the patient’s peritoneal cavity to treat peritoneal cancer.