SIRSPHERES 2006 FINAL CODING SHEET 3-15-06

1 CODING SHEET FOR PHYSICIAN & HOSPITAL OUTPATIENT SERVICESMARCH 2006 March 2006 Post-Treatment Follow Up Lab Visits (see page 8) PET Scan (see page 8) Post-Procedure Observation (See page 7) Liver Imaging (SPECT) SIR-Spheres microspheres Administration Supervision, Handling & Loading Place arterial catheter Interstitial radiation source application Patient Referral (see page 10) Cancer Center Medical Oncologists Interventional Radiology (see page 10) Consult Screening Lab Tests See page 13 (Appendix) PATIENT NOT ELIGIBLE Alternative Treatment 20% or Greater Shunting? Less than 20% Shunting? Nuclear Medicine (see page 3) Tc99 MAA Scan Diagnostic Radiology (see pages 1 - 3) CT Abdomen MRA Abdomen 3-D Post-Processing Baseline PET Angiography Phase 1: SIR-Spheres ScreeningPatient Eligible (See page 4 )Schedule Treatment SIR-Spheres Order 7-10 days prior to treatment DAY OF TREATMENT (See pages 6 7) Nuclear Medicine/Radiation Oncology(see pages 4 5) Clinical Treatment Planning Medical Radiation Dosimetry TREATMENT PLAN DOSE CALCULATION (pages 4 - 5) Phase 2: SIR-Spheres TreatmentSIR-SPHERES microspheres TREATMENT FLOW CHARTB ilirubin above PATIENT NOT ELIGIBLE SELECTIVE INTERNAL RADIATION THERAPY (SIRT) SIR-SPHERES TREATMENT CODING SIR-Spheres microspheres is indicated for the treatment of unresectable metastatic liver tumors from primary colorectal cancer.

2 The microspheres procedure is performed in the outpatient hospital setting and therefore the possible CODING options presented in this guide are applicable to outpatient CODING and payment based on Medicare s 2006 Hospital Outpatient (OPPS) and Physician fee schedule. The CODING options listed in this guide are not intended to be a recommendation for CODING , but only a suggested pathway to allow institutions and physicians to evaluate their own CODING decisions. Not all institutions or physicians will use the codes indicated because of different clinical specialties involved or institutions specific CODING practices or insurance payer requirements. Note: When performing multiple procedures, review current correct CODING guidelines carefully. Services that are considered a component of another procedure cannot always be coded and billed separately. Medicare s Correct CODING Initiative (CCI) is reviewed and updated several times a year.

3 Commercial payer policies vary and should be carefully reviewed. Current Procedural Terminology (CPT) is copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association. SIR-SPHERES SCREENING PATIENT EVALUATION 2006 OPPS Payment Rate Code Code Description APC/ Status APC DescriptorAPC Payment 2006 Medicare Physician Fee Schedule EVALUATION AND MANAGEMENT SERVICES: OFFICE VISTS & CONSULTATIONS For a complete summary of applicable E&M codes that may apply, see page 10 of this guide or consult your current CPT manual. 99201- 99205 Office or other outpatient visit for the evaluation and management of a new patient 600-602/ V Clinic Visits$ $ $ $ (Facility) $ $ (Non-Facility) 99211- 99215 Office or other outpatient visit for the evaluation and management of an established patient 600-602/ V Clinic Visits$ $ $ $ (Facility) $ $ (Non Facility) 99241- 99245 Office consultation for new or established patient 600-602/ V Clinic Visits$ $ $ $ (Facility) $ $ (Non-Facility)PRE-TREATMENT DIAGNOSTICS: LAB TESTS Screening Lab Tests See Appendix (page 13 of this guide) for a list of CODING options.

4 PRE-TREATMENT DIAGNOSTICS: RADIOLOGY Selective Catheterizations for Diagnostic Procedure Select catheterization code based on the most distal catheterization within the vascular family. If the same vascular access site is used for all same- day services, code the vascular access only once. If separate vascular access sites are used, code for each site. Refer to your current CPT manual for guidelines on correct CODING for selective vascular catheterization(s) 36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family N N/A N/A $ (Facility)$1, (Non-Facility) 36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family N N/A N/A $ (Facility)$1, (Non-Facility) 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family N N/A N/A $ (Facility) $2, (Non-Facility) 36248 Selective catheter placement, arterial system.

5 Additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate) N N/A N/A $ (Facility)$ (Non-Facility) APC Status Key: B=Not paid under OPPS; E=Non-covered items and services; H=Device category pass through and brachytherapy sources; K=Non-pass through Drugs, Biologicals, and Radiopharmaceutical Agents; N=Incidental services, packaged into APC rate; S=Significant procedure, not discounted when multiple; T=Procedure, discounted when multiple; X=Ancillary Services; V=Clinic Visit March 2006 1 This information is provided by Sirtex as a guide for CODING services involving SIR-Spheres and is not intended to increase or maximize reimbursement by any payer.

6 We strongly suggest consulting your third-party payer organizations with regard to local coverage, CODING and reimbursement policies. Providers assume full responsibility for all reimbursement decisions or actions. Current Procedural Terminology 2005 American Medical Association. All Rights Reserved. PRE-TREATMENT DIAGNOSTICS: RADIOLOGY (continued) 2006 OPPS Payment Rate Code Code Description APC/ StatusAPC Descriptor APC Payment2006 Medicare Physician Fee Schedule Fluoroscopy 76003 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) N N/A N/A $ (Global)$ (Prof)$ (Tech)Chest X-ray See Appendix (page 13 of this guide) for a list of CODING options. CT Chest 71250 Computed tomography, thorax; without contrast material 0332/SComputerized Axial Tomography and Computerized Angiography without Contrast $ $ (Global)$ (Prof)$ (Tech)71260 Computed tomography, thorax; with contrast material(s) 0283/SComputerized Axial Tomography with Contrast Material $ $ (Global)$ (Prof)$ (Tech)71270 Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections 0333/SComputerized Axial Tomography and Computerized Angiography w/o Contrast followed by Contrast $ $ Global)$ (Prof)$ (Tech)CT Abdomen 74150 Computed tomography, abdomen; without contrast material 0332/SComputerized Axial Tomography and Computerized Angiography without Contrast $ $ (Global)$ (Prof)$ (Tech)74160 Computed tomography, abdomen.

7 With contrast material(s) 0283/SComputerized Axial Tomography with Contrast Material $ $ (Global)$ (Prof)$ (Tech)74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 0333/SComputerized Axial Tomography and Computerized Angiography w/o Contrast followed by Contrast $ $ (Global)$ (Prof)$ (Tech)Ultrasound Abdomen 76700 Ultrasound, abdominal, B-scan and/or real time with image documentation; complete 0266/SLevel II Diagnostic Ultrasound $ $ (Global)$ (Prof)$ (Tech)76705 Ultrasound, abdominal, B-scan and/or real time with image documentation; limited (eg, single organ, quadrant, follow-up) 0266/SLevel II Diagnostic Ultrasound $ $ (Global)$ (Prof)$ (Tech)Bone Scan 78300 Bone and/or joint imaging; limited area 0396/SBone Imaging $ $ (Global)$ (Prof)$ (Tech)78305 Bone and/or joint imaging; multiple areas 0396/SBone Imaging $ $ (Global)$ (Prof)$ (Tech)78306 Bone and/or joint imaging; whole body 0396/SBone Imaging $ $ (Global)$ (Prof)$ (Tech)78315 Bone and/or joint imaging; three phase study 0396/SBone Imaging $ $ (Global)$ (Prof)$ (Tech)78320 Bone and/or joint imaging; tomographic (SPECT) 0396/SBone Imaging $ $ (Global)$ (Prof)$ (Tech)APC Status Key: B=Not paid under OPPS; E=Non-covered items and services; H=Device category pass through and brachytherapy sources; K=Non-pass through Drugs, Biologicals, and Radiopharmaceutical Agents; N=Incidental services, packaged into APC rate; S=Significant procedure, not discounted when multiple; T=Procedure, discounted when multiple; X=Ancillary Services.

8 V=Clinic Visit March 2006 2 This information is provided by Sirtex as a guide for CODING services involving SIR-Spheres and is not intended to increase or maximize reimbursement by any payer. We strongly suggest consulting your third-party payer organizations with regard to local coverage, CODING and reimbursement policies. Providers assume full responsibility for all reimbursement decisions or actions. Current Procedural Terminology 2005 American Medical Association. All Rights Reserved. PRE-TREATMENT DIAGNOSTICS: RADIOLOGY (continued) 2006 OPPS Payment Rate Code Code Description APC/ StatusAPC Descriptor APC Payment2006 Medicare Physician Fee Schedule Hepatic Angiogram Code for each basic examination performed( the superior mesenteric artery, inferior mesenteric artery and hepatic artery are each basic examinations.)

9 (For selective angiography, each additional visceral vessel studied after basic examination, use 75774.) 75726 Angiography, visceral, selective or supraselective, (with or without flush aortogram), radiological supervision and interpretation 0280/SLevel III Angiography and Venography $1, $ (Global)$ (Prof)$ (Tech)75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure)0279/SLevel II Angiography and Venography $ $ (Global)$ (Prof)$ (Tech)Nuclear Medicine Break Through Scan with TC-99 78201 Liver imaging; static only 0394/SHepatobiliary Imaging $ $ (Global)$ (Prof)$ (Tech)78202 Liver imaging; with vascular flow 0394/SHepatobiliary Imaging $ $ (Global)$ (Prof)$ (Tech)A9540 Technetium TC-99m macroaggregated albumin,diagnostic, per study dose, up to 10 millicuries N N/A N/A N/A MRA Abdomen 74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) B Facilities Should Use See C-Codes Below for Medicare Billing.

10 Private Payers Should be Contacted for their Billing Requirements $ (Global)$ (Prof)$ (Tech)C8900 MRA with contrast abdominal 0284/SMagnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast $ N/A C8901 MRA without contrast abdominal 0336/SMagnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast $ N/A C8902 MRA without contrast abdominal followed with contrast 0337/SMRI and Magnetic Resonance Angiography without Contrast Material Followed $ N/A Baseline PET 78811 Tumor imaging, positron emission tomography (PET); limited area (eg, chest, head/neck) 1513/SNew Technology - Level XIII ($1100 - $1200) $1, $ (Prof)Carrier Decision (Global & Tech)78812 Tumor imaging, positron emission tomography (PET); skull base to mid-thigh 1513/SNew Technology - Level XIII ($1100 - $1200) $1, $ (Prof) Carrier Decision (Global & Tech)S80851 Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence detection system (non-dedicated pet scan) N/A Not Applicable to Medicare; Private Payers Should be Contacted for their Billing Requirements 1 A95522 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries 1651/HF 18 fdg Hospital cost-to-charge ratio4N/A OTHER TREATMENT PLANNING SERVICES 77370 Special medical radiation physics consultation 0304/XLevel I Therapeutic Radiation Treatment Preparation $ $ 77470 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation) 0299/SMiscellaneous Radiation Treatment $ $ (Global)$ (Prof)$ (Tech)APC Status Key: B=Not paid under OPPS; E=Non-covered items and services.