1. Karen Scholtz
   Posted 5 months ago #
   

   Is this code patient specific or is it possibel that the provider can charge this for all stereotactic surgery patients or all patients that reuire BID treatment (This would be documented o as additional work required for planning i.e stereotac or B.I.D)

2. SuperCoder
   Posted 5 months ago #
   

   You can easily conclude from the CPT Assistant content below:
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   Spine and Spinal Cord: Spinal Stereotactic Radiosurgery

   The spine is the most frequent location for skeletal metastases, which occur in up to 40% of patients with cancer. Skeletal metastases occur most commonly in patients whose cancer presents in the following primary sites: the breasts (39.3%), prostate (23.5%), and lung (19.9%), and there is a slight male predominance. The thoracic spine is affected in up to 70% of cases, followed by the lumbar and cervical areas. Metastatic lesions of the spine may involve the epidural space, the paravertebral soft tissues, and bone. Initially, metastatic lesions usually involve the posterior vertebral elements. Lesions may be solitary or multiple and noncontiguous in nature. Debilitating pain may or may not be associated with metastatic spinal disease and pathological fracture.

   Treatment for spinal metastases includes spinal stereotactic radiosurgery, which is a distinct procedure that utilizes externally generated ionizing radiation to inactivate or eradicate defined target(s) in the spine without the need to make an incision. The target is defined and treatment is delivered using high-resolution stereotactic imaging. To ensure quality of patient care, these procedures involve a multidisciplinary team consisting of a neurosurgeon, a radiation oncologist, and a medical physicist.

   The neurosurgeon reports the appropriate code(s) for the stereotactic radiation surgery services. The radiation oncologist reports the appropriate code(s) for clinical treatment planning, physics and dosimetry, treatment delivery, and management from the Radiation Oncology section of the CPT codebook (codes 77261-77790). Any necessary planning, dosimetry, targeting, positioning, or blocking by the neurosurgeon is included in the stereotactic radiation surgery services. The same physician should not report stereotactic radiosurgery services with radiation treatment management codes (77427-77432).

   Technologies used to perform stereotactic radiosurgery include linear accelerators and particle beam accelerators. To enhance precision, various devices may incorporate robotics and real-time imaging.

   The following new codes were established in 2009 to report spinal stereotactic radiosurgery:

   63620Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion

   63621each additional spinal lesion (List separately in addition to code for primary procedure)

   Spinal stereotactic radiosurgery is typically performed in a single planning and treatment session using a stereotactic image-guidance system, but can be performed with a planning session and a limited number of treatment sessions, up to a maximum of five sessions. Codes 63620 and 63621 describe stereotactic radiosurgery treatment planning for lesions of the spine and are distinct from the technology used for stereotactic radiosurgery of cranial lesions.

   Stereotactic spinal surgery is used only when the tumor being treated affects spinal neural tissue or abuts the dura mater. Arteriovenous malformations must be subdural. (For other radiation services of the spine, refer to the Radiation Oncology section in the CPT codebook.)

   Code 63620 describes stereotactic radiosurgery performed on one spinal lesion. A parenthetical note was added following code 63620 instructing users not to report code 63620 more than once per course of treatment. Code 63621 is an add-on code that describes stereotactic radiosurgery performed on each additional spinal lesion and is reported in addition to code 63620 as appropriate. A parenthetical note was added following code 63621 instructing users that this code may not be reported more than once per lesion and no more than two times per each course of treatment, regardless of the number of lesions treated.

   Clinical Example (Code 63620)
   --------------------------------
   A 65-year-old man presents with prostate cancer metastatic to the C4 vertebral body and epidural space, resulting in mild narrowing of the central canal. He undergoes stereotactic spinal radiosurgery for the single metastatic tumor.

   Description of Procedure (Code 63620)
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   The patient is transported to the radiology department where stereotactic computerized imaging studies are obtained. (The imaging studies may be either magnetic resonance images or angiography [radiology services reported separately]). The neurosurgeon works with a radiologist to verify that the target is optimally imaged. Complex dosimetry planning follows in conjunction with radiation oncology and a radiation physicist. The computer processes all of the stereotactic images in a dose planning program during this phase. The neurosurgeon carefully outlines the target lesion where it appears on each consecutive image and outlines the spinal cord on the same images. This dose planning involves the use of a computer-based planning module to achieve an optimal dosimetry plan for the patient. Because of the nature of the lesion and its proximity to the spinal cord, several plans are developed using different prescribed doses and delivery geometry. The plan that achieves the greatest radiation dose to the target with the least radiation to the spinal cord is chosen. The patient is brought to the treatment device and positioned on the treatment table. The neurosurgeon is available to make changes in the treatment plan if optimal positioning cannot be achieved. The device automatically obtains positioning radiographs and compensates for the patient's actual position in the treatment device so that the expected treatment geometry matches the actual treatment geometry based on the bony landmarks of the spine. The neurosurgeon is available to make more changes in the treatment plan, if this image fusion resulting in registration of the spine fails. The treatment is then delivered.

   Clinical Example (Code 63621)
   -----------------------------
   A 45-year-old woman presents with breast cancer metastatic to the vertebral body and epidural space of T2 and T5. She has undergone stereotactic spinal radiosurgery for the first tumor and now, during the same session, undergoes stereotactic spinal radiosurgery for the second tumor.

   Description of Procedure (Code 63621)
   ---------------------------------------
   The patient is transported to the radiology department where stereotactic computerized imaging studies are obtained. (The imaging studies may be either magnetic resonance images or angiography [radiology services reported separately]). The neurosurgeon works with a radiologist to verify that the additional target is optimally imaged. Complex dosimetry planning follows in conjunction with radiation oncology and a radiation physicist. The computer processes all of the stereotactic images in a dose planning program during this phase. The neurosurgeon carefully outlines the additional target lesion where it appears on each consecutive image and outlines the spinal cord on the same images. This dose planning involves the use of a computer-based planning module to achieve an optimal dosimetry plan for the patient. Because of the multiple lesions and their proximity to each other and to the spinal cord, several plans are developed using different prescribed doses and delivery geometry. The plan that achieves the greatest radiation dose to the additional lesion (taking into account the treatment plan for the first lesion) without interfering with the first lesion treatment plan and achieves the least radiation to the spinal cord is chosen. The patient is brought to the treatment device and positioned on the treatment table. The neurosurgeon is available to make changes in the treatment plan for the additional lesion if optimal positioning cannot be achieved. The device automatically obtains positioning radiographs and compensates for the patient's actual position in the treatment device for the additional lesion so that the expected treatment geometry matches the actual treatment geometry based on the bony landmarks of the spine. The neurosurgeon is available to make more changes in the treatment plan for the additional lesion, if this image fusion resulting in registration of the spine fails. The treatment is then delivered.

   Changes in 2011 CPT Codes
   -------------------------
   Stereotactic radiosurgery code 61795, Stereotactic computerassisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure), was deleted in 2011 concurrent with the addition of three separate codes (61781, 61782, and 61783) distinguishing the various anatomic regions (intracranial, extracranial, or spinal, respectively).

   CPT code 61783, Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure), is an add-on code used to report stereotactic computer-assisted (navigational) procedures for the spinal region. However, code 61783 should not be reported in conjunction with codes 63620 or 63621 because these codes include computer-assisted planning.

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