Case2Code

Official Description

Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with primary craniotomy (List separately in addition to code for primary procedure)

Common Language Description

The CPT® Code 0735T refers to the preparation of a tumor cavity, which involves the placement of a radiation therapy applicator specifically for intraoperative radiation therapy (IORT) that is performed concurrently with a primary craniotomy. This procedure is crucial in the management of malignant brain tumors, as it allows for the direct application of high-dose radiation to the area surrounding the tumor cavity immediately after the tumor has been surgically removed. The primary goal of this treatment is to target any residual tumor cells that may remain in the margins of the resected tissue, thereby reducing the risk of tumor recurrence. Intraoperative radiation therapy is a sophisticated technique that requires meticulous planning and execution. Prior to the application of radiation, the surgical team carefully measures and maps the treatment area, ensuring that critical structures such as the brain stem and optic nerve are adequately protected. This involves the use of advanced imaging modalities, including ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), to visualize the surrounding anatomy and confirm the precise placement of the radiation applicator. The procedure is performed under sterile conditions, with the radiation applicator being draped and positioned within the tumor cavity. Once in place, radiation is delivered for a predetermined duration and intensity, tailored to the specific needs of the patient and the characteristics of the tumor. After the radiation treatment is completed, the applicator and any sterile draping are removed, and the surgical site is closed with careful attention to potential complications such as cerebrospinal fluid leakage or bleeding. It is important to note that IORT is considered a high-risk procedure, with potential complications that may include infection, delayed healing requiring further surgical intervention, cerebral bleeding or ischemia, radiotoxicity, and symptomatic brain necrosis. These risks necessitate thorough preoperative planning and postoperative monitoring to ensure patient safety and optimal outcomes.

1. Indications

The procedure described by CPT® Code 0735T is indicated for patients undergoing treatment for malignant neoplasms of the brain. The specific indications for this procedure include:

Malignant Brain Tumors - This procedure is performed following the resection of malignant tumors to target residual tumor cells in the surrounding brain tissue.
High-Risk Tumor Margins - It is indicated when there is a need to deliver high-dose radiation to the margins of the tumor cavity to prevent recurrence.
Concurrent Treatment with Craniotomy - The procedure is indicated to be performed concurrently with a primary craniotomy, ensuring immediate treatment of the tumor site.

2. Procedure

The procedure for CPT® Code 0735T involves several critical steps to ensure the effective delivery of intraoperative radiation therapy (IORT). These steps include:

Step 1: Tumor Resection - The initial step involves the surgical resection of the malignant neoplasm from the brain. This is performed through a craniotomy, which allows access to the tumor site.
Step 2: Measurement and Mapping - After tumor removal, the surgical team meticulously measures and maps the tumor cavity and surrounding areas. This includes assessing the distance from critical structures such as the brain stem and optic nerve to ensure their protection during radiation delivery.
Step 3: Shielding at-Risk Tissue - Tissue that is at risk of coming into contact with the radiation therapy applicator is carefully shielded to minimize potential damage from radiation exposure.
Step 4: Placement of Radiation Applicator - The radiation therapy applicator is then sterilely draped and positioned within the tumor cavity. This step is crucial for ensuring that the radiation is delivered accurately to the intended area.
Step 5: Intraoperative Imaging - Intraoperative imaging techniques, such as ultrasound, CT, or MRI, are utilized to visualize the nearby structures and confirm the correct placement of the applicator.
Step 6: Delivery of Radiation - Once the applicator is in place, radiation is delivered for a calculated duration and intensity, tailored to the specific needs of the patient and the characteristics of the tumor.
Step 7: Removal of Applicator and Closure - After the radiation treatment is completed, the IORT applicator and sterile draping are removed. The surgical wound is then closed, with careful attention to any potential complications such as cerebrospinal fluid leakage or bleeding.

3. Post-Procedure

Post-procedure care following the application of CPT® Code 0735T involves monitoring for potential complications and ensuring proper recovery. Patients are typically observed for signs of infection, bleeding, or cerebrospinal fluid leakage at the surgical site. Additionally, the surgical team may implement measures to manage pain and promote healing. Follow-up imaging may be required to assess the treatment area and ensure that there are no signs of tumor recurrence or other complications. Given the high-risk nature of IORT, ongoing evaluation and support are essential to address any adverse effects that may arise during the recovery process.

Short Descr	PREP TUM CAV IORT PRIM CRNOT
Medium Descr	PREPJ TUMOR CAVITY IORT CNCRNT W/PRIM CRANIOTOMY
Long Descr	Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with primary craniotomy (List separately in addition to code for primary procedure)
Status Code	Carriers Price the Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
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)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

61510	MPFS Status: Active Code APC C Physician Quality Reporting Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma
61512	MPFS Status: Active Code APC C Physician Quality Reporting Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial
61518	MPFS Status: Active Code APC C Physician Quality Reporting Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull
61519	MPFS Status: Active Code APC C Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma
61521	MPFS Status: Active Code APC C CPT Assistant Article Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull

AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC	This service has been performed in part by a resident under the direction of a teaching physician