A CPT code (Current Procedural Terminology) provides an accurate description of medical,

surgical, and diagnostic services of health care providers in a uniform way. CPT codes are five
digit numeric codes that range from 00100 through 99499; a two digit modifier may be added to
clarify the description of the procedure1. The radiation oncology five digit CPT codes, which
utilize 77xxx as the modifier, may be combined in a number of ways to code and describe the
entire course of treatment1. Each complete radiation treatment course is determined by the
individual patient's needs and the services provided. The CPT codes grouped into the six
services in the process of radiation oncology care. These six services are the initial consultation,
preparing for treatment (simulation), medical radiation physics, dosimetry, treatment devices and
special services (dosimetry/ treatment plan development), daily radiation treatment delivery,
radiation treatment management (weekly OTV), and follow-up care management2.
ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) is used
to code a diagnosis: signs, symptoms, injuries, diseases, and conditions1. These codes provide
validation for the procedures performed and supplies used. There is a critical relationship
between ICD-9 (diagnosis) and CPT (service) codes. Insurers often compare the procedure codes
(CPT) to the diagnosis codes (ICD-9) to ensure the claim meets their medical necessity policies;
for example, a bill for CPT code identifying a colonoscopy (service) would not be supported by
an ICD-9 code identifying a (diagnosis). This claim would be rejected and unpaid by the insurer
as the services preformed do not correlate with the diagnosis code used.
The National Center for Health Statistics (NCHS) is responsible for coordinating all official
disease classification activities in the United States relating to the ICD system and its use,
interpretation and periodic revision1. ICD codes are updated annually, and changes go into effect
on October 1 of each year. This year on October 1st, ICD-10 (10th revision) began being used
nationally. ICD-10 codes are a more nationalized coding for a more specific diagnosis. An
example of the need for revision is a patient with cancer of the lip and another patient with
cancer of the gums would both have to use the same ICD-9 code for the oral cavity as it includes
the lips, gums, teeth, hard palate, cheek mucosa, tongue, and floor of the mouth. Now with ICD10 one patient could use a code specifically for gum cancer and the other patient could use an
entirely different code specific for lip.

1. Lenards N. Operational Issues in Radiation Oncology: Billing and Coding. [Power

Point]. La Crosse, WI: UW-L Medical Dosimetry Program; 2011.
2. Lenards N. Operational Issues in Radiation Oncology: Radiation Oncology
Coding. [Power Point]. La Crosse, WI: UW-L Medical Dosimetry Program; 2011.