CPT® Code 49412

1. Indications

The placement of interstitial devices for radiation therapy guidance, as described by CPT® Code 49412, is indicated for the following conditions:

• Malignant Tumors The procedure is performed to assist in the precise targeting of malignant tumors during radiation therapy.
• Radiation Dose Measurement Implantable dosimeters are utilized to measure the radiation dose at the tumor site, ensuring accurate delivery of treatment.
• Pre-Radiation Therapy Preparation The placement of fiducial markers and dosimeters is a preparatory step prior to initiating radiation therapy.

2. Procedure

The procedure for the placement of interstitial devices involves several critical steps to ensure accurate positioning and effectiveness:

• Step 1: Site Identification The first step involves identifying and measuring the planned placement sites for the interstitial devices within the abdomen, pelvis, or retroperitoneum. This is typically done using imaging guidance, which may include techniques such as ultrasound or CT scans to visualize the tumor and surrounding anatomy.
• Step 2: Anesthesia Administration Once the sites are identified, a local anesthetic is administered to numb the tissue along the planned insertion points. This step is crucial for minimizing discomfort during the procedure.
• Step 3: Device Insertion Using radiologic guidance, one or more fiducial markers or dosimeters are passed through an introducer needle into the tumor and/or the surrounding tissue. The use of imaging ensures that the devices are accurately placed in relation to the tumor.
• Step 4: Verification of Placement After the devices are inserted, their positions are checked radiographically to confirm that they are correctly placed within or around the tumor. This verification step is essential to ensure the effectiveness of the radiation therapy that will follow.
• Step 5: Completion of the Open Procedure In CPT® Code 49412, the placement of the interstitial devices occurs during a separately reportable open procedure. The selected sites for the fiducial markers and/or dosimeter are confirmed, and the devices are advanced into the appropriate tissues. Imaging guidance is utilized as needed throughout this process to ensure proper placement. Once the devices are in place, the open procedure is completed, and the operative wound is closed.

3. Post-Procedure

Post-procedure care following the placement of interstitial devices involves monitoring the patient for any immediate complications related to the open procedure. Patients may be advised to rest and avoid strenuous activities for a specified period to facilitate healing. Follow-up imaging may be required to confirm the continued proper placement of the fiducial markers and dosimeters. Additionally, the healthcare provider will provide instructions regarding any signs of infection or other complications that the patient should monitor as they recover.