Coding Question: Can we bill for a treatment device for a wing-board or a breast-board?
Coding Answer: A standardized device that is modified for each patient (like a belly-board, breast-board, etc.) should be billed with CPT® code 77332. If it is a custom fabricated device, specifically designed for a patient and not reusable for different patients during that course of therapy, it should be billed under CPT code 77334, e.g., thermoplastic immobilization device or custom-formed vacuum cushions. These devices require direct input from the physician for design, selection, placement and daily reproduction. If a wing-board or breast-board is used in addition to a custom immobilization device, only the custom device would be billed (CPT code 77334).
Coding Question: How do you bill for dose calculations and treatment devices for field-in-field tangents with every-other-day chest wall bolus? Should multiple 77334-PC charges be submitted when MLC-shaped apertures are delivered in a single unique deliverable field? I understand that only a single 77334-TC charge is appropriate for a treatment field that is modulated by merging a succession of MLC-shaped apertures ("segments") into a single unique deliverable field. However, the physician will review each individual MLC shaped aperture in the 3D isodose plan. Therefore, should the 77334-PC reflect the absolute number of MLC shaped apertures or just a single?
Coding Answer: A more complex example is “field-in-field”(FIF) tangents used in breast radiotherapy. A single technical and professional charge is appropriate for each tangent treatment field that is modulated by merging a succession of MLC-shaped apertures in a single deliverable field.
If a custom bolus is used for the chest wall, CPT 77333 (treatment device, intermediate) would be charged. The immobilization devices would be under 77332 (treatment device, simple); however if CPT 77333 is billed, there is an NCCI edit that does not allow for 77332 to also be billed.
CPT 77300 can be billed for each field with and without bolus.
Coding Question: Is 77300 billed for each field of an IMRT plan up to 10 fields? How are billable units of 77300 determined for a Volumetric Modulated Arc Therapy (VMAT) plan?
Coding Answer: In VMAT treatment courses, a patient is usually treated with one or two arcs; some brain treatments require a third arc. One unit of 77300 can be charged per arc. Therefore, there are one to three charges of 77300 for a typical VMAT plan.
In “step and shoot” or compensator based IMRT treatment courses, one unit of 77300 can be charged per gantry angle. Therefore, the units of 77300 charged would correspond to the number of gantry angles in the IMRT plan, frequently up to 10 units. For either step-and-shoot IMRT or VMAT techniques, verification of the dose may be performed by a wide variety of systems such as but not limited to ion chamber and fluence measurements, or portal dosimetry prior to the plan being used clinically.
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®) 2022, American Medical Association. All Rights Reserved.
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