CPT® Code 0182T | Case2Code

Code deleted, to report see 0394T, 0395T

Official Description

High dose rate electronic brachytherapy, per fraction

Common Language Description

High dose rate (HDR) electronic brachytherapy is a specialized form of radiation therapy that utilizes an x-ray tube to deliver electronically generated photons as the radiation source. This innovative approach eliminates the need for traditional radioactive isotopes, making the procedure safer and more efficient. HDR electronic brachytherapy is primarily indicated for the treatment of breast cancer, particularly following a lumpectomy, where the goal is to target and destroy any remaining cancerous cells in the tumor bed. The procedure involves the insertion of a brachytherapy applicator device into the body, either directly into the tissue surrounding the tumor (intrastitial) or into a body cavity (intracavitary). This precise placement allows for targeted radiation delivery to the affected area. Before treatment, the radiation oncologist assesses the target volume that requires treatment and determines the appropriate dose of radiation. This planning phase may involve the use of computerized brachytherapy dosimetry to refine the treatment plan, ensuring optimal delivery of radiation while minimizing exposure to surrounding healthy tissues. During the procedure, a shielding device is applied to protect normal tissue from radiation exposure, and additional external shielding may be utilized as necessary. The control panel is set to deliver the prescribed dose, and the x-ray generator is activated to administer the high dose electronic brachytherapy to the tumor or tumor bed for a specified duration, typically ranging from 10 to 40 minutes. The treatment is divided into fractions, with a standard regimen following lumpectomy consisting of 10 fractions delivered over five days, with two fractions administered each day. Each fraction is reported separately, and the brachytherapy applicator remains in place until the completion of the entire treatment course.

1. Indications

The primary indications for high dose rate electronic brachytherapy include the following:

Treatment of Breast Cancer This procedure is specifically utilized for patients diagnosed with breast cancer, particularly after undergoing a lumpectomy, to target residual cancerous cells in the tumor bed.

2. Procedure

The procedure for high dose rate electronic brachytherapy involves several critical steps to ensure effective treatment delivery:

Step 1: Implantation of the Brachytherapy Applicator Initially, a separately reportable implantation procedure is performed where the brachytherapy applicator device is inserted into the body at the site of the malignant neoplasm or the lumpectomy site. This can be done either intrastitially, where the applicator is placed directly into the tissue, or intracavitarily, where it is inserted into a body cavity.
Step 2: Verification of Target Volume Once the applicator is in place, the radiation oncologist verifies the target volume that needs to be treated. This step is crucial for ensuring that the radiation is accurately directed to the area of concern.
Step 3: Treatment Planning The oncologist may make necessary refinements to the treatment plan using computerized brachytherapy dosimetry, which helps in calculating the precise dose of radiation required for effective treatment.
Step 4: Application of Shielding A shielding device is then applied to protect normal tissues from radiation exposure. Additional external shielding may also be utilized as needed to further safeguard surrounding healthy areas.
Step 5: Setting the Control Panel The prescribed dose of radiation is set on the control panel, and a check run of the x-ray generator is performed to ensure proper functioning before treatment begins.
Step 6: Delivery of Radiation The control panel is activated to deliver the prescribed dose of radiation. The x-ray generator is turned on, and the high dose electronic brachytherapy is administered to the tumor or tumor bed for the prescribed duration, which typically ranges from 10 to 40 minutes.
Step 7: Repetition for Multichannel Applicators If a multichannel applicator is used, the process of setting the dose and delivering radiation may be repeated as necessary to ensure comprehensive treatment.
Step 8: Fractionation of Treatment The treatment is divided into fractions, with a typical regimen following lumpectomy consisting of 10 fractions delivered over five days, with two fractions administered each day. Each fraction is reported separately, and the brachytherapy applicator remains in place until the entire treatment course is completed.

3. Post-Procedure

After the completion of high dose rate electronic brachytherapy, patients may be monitored for any immediate side effects or complications. The brachytherapy applicator is typically left in place until the entire treatment course is completed, ensuring that the prescribed doses are accurately delivered. Patients may experience some localized discomfort or skin reactions in the treated area, which should be managed according to the healthcare provider's recommendations. Follow-up appointments will be necessary to assess the treatment's effectiveness and to monitor for any potential recurrence of cancer.

Short Descr	HDR ELECT BRACHYTHERAPY
Medium Descr	HDR ELECTRONIC BRACHYTHERAPY PER FRACTION
Long Descr	High dose rate electronic brachytherapy, per fraction
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	6 - Therapeutic Radiology
Berenson-Eggers TOS (BETOS)	P7B - Oncology - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	211 - Therapeutic radiology