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).
: How does one bill for dose calculations and treatment devices for field-in-field?
CPT code 77334-TC, Treatment Devices, Design and Construction; Complex, is used to report the work of creating the MLC delivery pattern for each unique deliverable treatment field. 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. CPT code 77300 Dosimetry, basic can be billed for each unique deliverable treatment field. However, if the devices use the same MLC delivery pattern then only one 77334 would be charged. If a succession of MLC-shaped apertures cannot be merged into a single deliverable field for unavoidable technical reasons, and therefore each of these smaller fields must be beamed-on separately, it is appropriate to charge one 77334-TC per smaller field. The bolus would be recognized by CPT code 77332 Treatment Device Simple, however it would not be separately billed in combination with 77334. A separate 77300 could be charged for each field 1) with and 2) without bolus, since the presence of the bolus changes the calculation of monitor units for that field.
Coding Question: Is 77300 billed for each field of an IMRT plan up to 10 fields? How do you check multiple fields in a Volumetric Modulated Arc Therapy plan?
Coding Answer: In arc treatment courses, a patient is usually treated with one or two arcs; some brain treatments require a third arc. Typically, one unit of 77300 can be charged per arc to cover the verification of the dose. Therefore, there are one to three charges of 77300 for a typical arc plan.
In “step and shoot” or compensator based IMRT treatment courses, one unit of 77300 can be charged per angle to cover the independent monitor unit calculation. Therefore, the units of 77300 charged would correspond to the number of gantry angles in the IMRT plan, frequently up to 10 units. In either IMRT technique, 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.
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.
CPT is registered trademark of the American Medical Association.