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Does IGRT requires direct or general supervision?

Ana Posted Tue 18th of March, 2014 09:17:51 AM

"77421 or 77014" requires direct supervison?

SuperCoder Answered Wed 19th of March, 2014 01:37:41 AM

The relevant supervision levels for technical 77421 (Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy) include:

• (02) Direct supervision: When your physician is present and immediately available to furnish direction and assistance throughout the procedure, consider it "direct supervision." Remember, however, that "direct supervision" doesn't mean your physician must be present in the room during the procedure -- just that he's in the vicinity and immediately available in person if needed.

• (03) Personal supervision: "Personal supervision does not mean the doctor has to perform the procedure; he just has to be there in person supervising the procedure.

From Coding alert-

"Single Out 77421 for Success

Ultrasonic and CT guidance may be easy to spot in your documentation, but if you need a little more help with stereoscopic X-ray guidance, CPT Changes 2006: An Insider's View offers some helpful hints.

For 77421, the "technology detects any 3D deviations between actual and planned target position." The clinical example in CPT Changes 2006 includes placement of infrared markers either on the patient or treatment couch to monitor position, kV or mV stereoscopic X-ray imaging of internal anatomy or implanted markers just before treatment, comparison of those images with digital reconstructed radiographs (DRRs) from treatment planning to identify discrepancies, and addressing any deviations by adjusting patient position. In addition, the radiation oncologist reviews the images daily, compares them with previous shifts, and offers feedback to the radiation therapist, according to CPT Changes 2006.

You can use 77421 for most prostate cases requiring IGRT, as well as for head and neck cancer cases and some breast patients. The patients with prostate cancer "have fiducial markers placed. For the other ones we use the bony anatomy to find the tumor/target volume,".

And don't forget that in 2009 Medicare changed 77421's technical component supervision requirement to direct supervision (02). Direct supervision means the oncologist doesn't have to be in the room, she just needs to be in the same office suite, readily available to offer assistance if necessary."

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