Daily Practice

Treatment Planning

Coding Question: What does the physician's request for a special physics consultation 77370 need to entail? Can it be a box that is checked off and initialed by the MD?

Coding Answer: A special physics consultation (CPT® code 77370) requires a written request that is signed and dated by a physician. A simple check-off box in the patient chart is not sufficient and a description of the purpose of the consult is necessary. However, a descriptive special physics consultation order for common uses may be developed.  Regardless, the request must be specific to a particular patient and must address the particular problem and/or service that requires the expertise of a qualified medical physicist.

Coding Question: What does the physicist’s report for special physics consultation 77370 need to include? Can it be a box that is checked off and initialed by the physicist?

Coding Answer: A special physics consultation (CPT® code 77370) requires a report that is signed/dated by a qualified medical physicist and approved/dated physician. A simple check-off box in the patient chart is not sufficient and a description of the results of the consult is necessary. A descriptive special physics consultation summary for common uses may be developed to facilitate this task but should be accompanied by a customized special physics consultation report that is appended to the patient’s chart.

Coding Question: When an emergency patient starts treatment on the same day of the first visit, how can the IMRT plan, simulation, and IMRT treatment be billed on the same day?

Coding Answer: The necessity for generation of an IMRT plan (77301) in an emergent setting would be highly unusual. However, a new patient visit (99201-99205) may be billed on the same day as an IMRT plan (77301) with an associated modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if it is appropriately justified. There are NCCI edits that preclude the billing of an IMRT plan (77301) with a complex simulation (77290). An IMRT plan (77301) may be billed on the same day as an IMRT treatment (G6015, G6016, 77385, or 77386).

Coding Question: CPT® codes for reporting a teletherapy isodose plan (77306-77307) or a brachytherapy isodose plan (77316-77318) states that Basic Radiation Dosimetry (77300) is bundled into these codes. Has there been any bundling of 77300 for IMRT planning (77301) and 3-D planning (77295)? Also, can we bill 77300 with Special Teletherapy Port Plan (77321)?

Coding Answer: CPT code 77300 is not bundled into either 77301 or 77295 and can still be reported with these codes. However, a separate 77300 cannot be reported with CPT code 77321. The work of 77300 is already captured in the planning code (77321). If a particle beam is planned for delivery without an isodose plan (77321, 77306 or 77307), then CPT code 77300 can still be reported. If the particle beam plan rises to the level of 77295 or 77301, CPT code 77300 can be utilized.

Coding Question: When a patient presents with distinct disease sites that require different immobilizations devices and/or CT simulations performed on the same day which possibly require different treatment techniques (e.g. SRS and IMRT) can we submit simulation and planning charges for each site separately? 

Coding Answer: When treatment planning for different sites is fully independent, i.e. requiring the work equivalence of a new patient (different immobilization, CT, target and avoidance structures, dose objectives/constraints…) it is appropriate to submit planning and ancillary procedure charges for each of the plans/sites.  Even if multiple planning charges are warranted, when both sites are CT simulated on the same day there should only be one set of charges related to the CT procedure despite the need for multiple setups and scans.

Coding Question: If a patient is planned and treated with multiple modalities, e.g. IMRT and electrons or IMRT and protons, can charges be submitted for each plan if they are based on the same CT?  Does it matter if the planned targets are the same (e.g. both modalities targeting the PTV) or different (one modality targeting the PTV and the other the GTV)?

Coding Answer: If the targets are the same and only one CT dataset is used, you should bill only one IMRT plan. If you are using same treatment planning system, to generate multiple plans (using any modality of treatment and energies (electrons + photon or photon + proton)) to achieve your goals, then only one IMRT plan should be billed.  If you have to use different treatment planning systems and the PTVs can’t be imported, requiring the physician to regenerate PTVs and OAR, OR the contours are generated on a separate system for export to the different treatment planning system, on the same CT data set then only one IMRT charge may be submitted. If clinically indicated, two IMRT treatment plans may be billed if a second CT dataset and contouring are required to perform a boost treatment. 

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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