Basics of CPT code 79101 and 79005

There are many radiology procedure codes in CPT codebook. But, it is really difficult to understand the procedure performed behind the CPT code. As we have seen previously, the use of radioactive agent for parathyroid imaging and bone scan procedure codes, which are also a part of radiology procedure codes. In this article again we are going to learn more about the use of radiopharmaceutical therapy for thyroid procedures for CPT code 79101 and 79005. Yes, we are going to learn the oral and intravenous administration of radioactive agent to diagnose the abnormalities of thyroid gland. Let us check more about these procedures.Read also: difference between the diagnostic and therapeutic procedures

Exam performed for CPT code 79101 and 79005

The radiopharmaceutical therapy for thyroid gland can be done by oral or intravenous administration. The CPT codes 79005 and 79101 are differentiated by the technique of the exam performed. In this exam, a radiopharmaceutical agent is given intravenous or orally. For oral exam the patient swallows the radiolabeled substance. The technique is to attach the radiolabeled molecules to the specific tissue seeking molecules. The activity of these radioactive substances helps in diagnosing different types cancer or malfunctioning tissues.

For example, of radioactive iodine, I-131 given to the patient orally, to treat thyroid cancers and hormone overproduction (hyperthyroidism) since iodine is specifically taken up by thyroid cells. The same procedure follows in intravenous administration.

The patient is injected or instilled radiolabeled substance directly in a vein. For example, a radioactive phosphorus, P-32 as sodium phosphate administered by intravenous injection, since phosphorus-32 has a high bone marrow toxicity, it is used for treating polycythemia vera and chronic leukemia to slow the rate at which bone marrow produce cells and induce a state of remission. These exams are slightly different from the thyroid exams for 78018 CPT code or thyroid ablation therapy procedures. HCPCS code are also assigned for the radioactive agent used for these procedures.

79005 – Radiopharmaceutical therapy, by oral administration

79101– Radiopharmaceutical therapy, by intravenous administration

Oral administration of radioactive iodine (I-131) is a treatment for thyroid cancer and hyperthyroidism. The radiopharmaceutical agent can be provided in liquid or capsule form.

Some radiopharmaceutical codes are defined as per millicurie, while others are defined as per microcurie, per 100 microcuries, or per treatment dose.

A curie contains 1 thousand millicuries and 1 million microcuries.

When determining how many units of the code to report, always follow the code definition. Do not report the units based on the number of containers or syringes.

A9530 Iodine I-131 sodium iodide solution, therapeutic, per millicurie

A9604 Samarium SM-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries

A9606 Radium Ra-223 dichloride, therapeutic, per microcurie

When assigning codes for therapeutic radiopharmceuticals, always make certain the code definition includes the word “therapeutic“.

A patient is treatment with a caspue containing 10mCi of I-131 for treatment of hyperthyroidism.

The physician and hospital should bill as follows:

Physician 79005-26

hospital 79005, A9517x10 units

Code A9517 is defines as “Iodine I-131 sodium iodide capsule(s), therapeutic, per millicurie“. Since the patient received 10 millicuries, 10 unites of code A9517 should be reported.

Read also: Coding guide for Parathyroid CPT codes in Radiology

Sample Report for CPT code 79101

PROCEDURE
Lutetium 177 (Lu-177) vipivotide tetraxetan (PSMA-617) nuclear medicine prostate cancer therapy

TECHNIQUE
Intravenous infusion of 205 mCi of Lu-177 PSMA-617 for the treatment of metastatic prostate cancer without any immediate complications

FINDINGS
Pre-Procedure
Pre-therapy laboratory values were reviewed and were within an acceptable range for treatment. The patient’s PSMA PET/CT scan was reviewed, which demonstrated PSMA-positive disease.

The risks, benefits, and alternatives of Lu-177 PSMA-617 treatment were discussed with the patient. Specifically, the patient was counseled on the risks of nausea; vomiting; fatigue; lowering of white blood cells, red blood cells, and platelet counts; kidney toxicity; and dry mouth and eyes, which could become permanent. The patient agreed to proceed with the treatment, and written informed consent was obtained. The patient was instructed to stay well-hydrated on the day of the infusion.

Posttreatment
Radiation safety precautions were discussed with the patient, and the patient was given guidance regarding the signs and symptoms of potential complications. This information was also given to the patient in the form of written take-home instructions. The patient was instructed to follow up with his referring physician for post-therapy laboratory monitoring.

Posttreatment Plan
The patient is instructed to resume care by his clinical team. This is the fifth of six total planned treatments. The patient is instructed to return after 6 weeks for the final treatment. Complete blood count and complete metabolic panel will be monitored at regular intervals while the patient is undergoing treatment.

CPT codes:
79101 Radiopharmaceutical therapy, by intravenous administration
A9607 x205 Lutetium Lu-177 vipivotide tetraxetan, therapeutic, 1 millicurie
C61 Malignant neoplasm of prostate
C79.51 Secondary malignant neoplasm of bone

This report describes a nuclear medicine therapeutic intravenous infusion procedure for the treatment of metastatic prostate cancer and is appropriately reported with Current Procedural Terminology (CPT) code 79101. The therapeutic radiopharmaceutical drug administered is reported separately with the Healthcare Common Procedure Coding System (HCPCS) Level II code A9607, Lutetium Lu-177 vipivotide tetraxetan, therapeutic, 1 millicurie. Note that 205 mCi of Lu-177 PSMA-617 was administered, so 205 units should be reported (ie, A9607 x205).

If evaluation and management (E/M) services were performed, E/M codes should be reported for the pre- and posttreatment evaluation for Lu-177 therapy. E/M codes are divided into several categories, and the CPT codebook should be referenced for appropriate, specific guidelines.

Additional Code Information for CPT code 79101 and 79005

HCPCS codes related to CPT Code 79101 and 79005

A4641 Radiopharmaceutical, diagnostic, not otherwise classified
A4642 Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
A9500 Technetium Tc-99m sestamibi, diagnostic, per study dose
A9502 Technetium Tc-99m tetrofosmin, diagnostic, per study dose
A9503 Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
A9505 Thallium Tl-201 thallous chloride, diagnostic, per millicurie
A9507 Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
A9508 Iodine I-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
A9509 Iodine I-123 sodium iodide, diagnostic, per millicurie
A9510 Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
A9512 Technetium Tc-99m pertechnetate, diagnostic, per millicurie
A9515 Choline C-11, diagnostic, per study dose up to 20 millicuries
A9516 Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
A9517 Iodine I-131 sodium iodide capsule(s), therapeutic, per millicurie
A9520 Technetium Tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
A9521 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
A9524 Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries
A9526 Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries
A9527 Iodine I-125, sodium iodide solution, therapeutic, per millicurie
A9528 Iodine I-131 sodium iodide capsule(s), diagnostic, per millicurie
A9529 Iodine I-131 sodium iodide solution, diagnostic, per millicurie
A9530 Iodine I-131 sodium iodide solution, therapeutic, per millicurie
A9531 Iodine I-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)
A9532 Iodine I-125 serum albumin, diagnostic, per 5 microcuries
A9537 Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
A9538 Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
A9539 Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries
A9540 Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries
A9541 Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
A9542 Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries
A9543 Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries
A9547 Indium In-111 oxyquinoline, diagnostic, per 0.5 millicurie
A9548 Indium In-111 pentetate, diagnostic, per 0.5 millicurie
A9551 Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries
A9552 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9553 Chromium CR-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries
A9554 Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries
A9555 Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries
A9556 Gallium Ga-67 citrate, diagnostic, per millicurie
A9557 Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
A9558 Xenon Xe-133 gas, diagnostic, per 10 millicuries
A9560 Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
A9561 Technetium Tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
A9562 Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
A9563 Sodium phosphate P-32, therapeutic, per millicurie
A9564 Chromic phosphate P-32 suspension, therapeutic, per millicurie
A9567 Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
A9568 Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
A9569 Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
A9570 Indium In-111 labeled autologous white blood cells, diagnostic, per study dose
A9571 Indium In-111 labeled autologous platelets, diagnostic, per study dose
A9572 Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
A9582 Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
A9584 Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
A9586 Florbetapir F-18, diagnostic, per study dose, up to 10 millicuries
A9587 Gallium Ga-68, dotatate, diagnostic, 0.1 millicurie
A9588 Fluciclovine F-18, diagnostic, 1 millicurie
A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
A9598 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
A9600 Strontium SR-89 chloride, therapeutic, per millicurie
A9604 Samarium SM-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
C9898 Radiolabeled product provided during a hospital inpatient stay
Q9982 Flutemetamol F-18, diagnostic, per study dose, up to 5 millicuries
Q9983 Florbetaben F-18, diagnostic, per study dose, up to 8.1 millicuries