Coding Question: A previously treated patient has imaging studies performed after the conclusion of radiation therapy. The radiation oncologist requests a special medical physics consultation to fuse the simulation CT and radiation dose to the follow-up imaging study to evaluate tumor response and/or organs-at-risk (OAR) damage with respect to the dose delivered. Can a 77370 be billed even though the patient is not undergoing a course of treatment?
Coding Answer: CPT® code 77370 (Special medical radiation physics consultation) is used when the radiation oncologist makes a direct request to the qualified medical physicist for a special consultative report or for specific physics services for an individual patient. This service is generally associated with a specific course of treatment. However, situations may arise where an analysis and written report is necessary to address a specific problem and when the service to be performed requires the expertise of a qualified medical physicist to provide information regarding past treatments to inform the physician’s decision making process. An example might be the analysis of the effects of previous radiation therapy with assessment of cumulative radiation dose to critical organs requiring fusion of previous planning CTs, dose distributions, OARs, treatment volumes, follow-up imaging studies, etc.
Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2015, American Medical Association. All Rights Reserved.
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