77470, Special treatment procedure, is generally used to report the additional physician time and effort required while managing special treatment situations. The following is a list of situations when the usage of this code could be implemented.

* The use of Brachytherapy (Implants/HDR)
* Hyperthermia
* Stereotactic Radiosurgery
* Conformal Treatment Management
* 3-D
* Hemibody or Total Body Irradiation
* Hyperfractionation
* IMRT
* Proton Beam Therapy
* Combination of Radiation and Chemotherapy
* Retreatment of the same site
* Dual energy beams

It is important to know that hormones such as Femara, Lupron, Tamoxifen, Magace, Prempo and Estrace are not included in this CPT code.

Additional consuming treatment management situations also may be used that enable the physician to bill for this code. 77470 may only be reported once per course of therapy.

It has a technical a professional component. 77470 may also be reported in addition to conventional complex treatment planning 77263.

BILLING TIP

In most cases, you would not use 77470, if a 77261 (Treatment planning, Simple) or 77262 (Treatment planning, Intermediate) is used, because these treatment planning codes do not require complex planning. There is no need to bill 77470 since there is no extra time and effort needed. It is most commonly used in curative cases, not palliative cases! One example of the exception to this rule is if a patient’s spine has been treated, and the spine needs to be irradiated again. This would be appropriate under the category of retreatment of the same site.

Freestanding Facilities would use code 77470 as a global charge. Hospital based facilities would use 77470-TC. Physician groups in a hospital-based facility would use 77470-26. According to the 4-16-01 AMA Coding Manager 2001, 77470 is mutually exclusive with 77427, weekly management code. Modifier 59, distinct procedural service is needed to unbundle this code in emergency patient start situations (The physician usually completes this task after the consult but before the first radiation treatment). The modifier 59 should be attached to 77427-59.

The staff should try to have this CPT code billed prior to the first treatment. This can be on the day of the CT simulation, 77290 or simple block verification simulation, 77280.

For your information, a 77470, Special Treatment Procedure Form is enclosed. It must be filled out entirely by the physician, along with his/her signature and full date to include year.

Always remember that the date on the sheet should match the date billed.