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PLAN BILLED AS IMRT & BOOST AS ISODOSE PLAN

Ana Posted Tue 30th of October, 2012 14:24:13 PM

Hospital bease dosimetrist is asking if the original plan was b illed as IMRT but, the boost is being billed down as isodose plan comples. May this be done, or should this only be if medically necessary with documentation why was this considered necessary?
Thnks,

SuperCoder Answered Tue 30th of October, 2012 22:04:38 PM

Generally, you shouldn’t report these two codes together. Code 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) includes the services described by 77295 (Therapeutic radiology simulation-aided field setting; three-dimensional), according to the American College of Radiology and most, if not all, payers.

Intensity modulated radiotherapy (IMRT) planning (77301) includes dose verification and positional accuracy plans, dose volume histograms for target and critical structure partial tolerances, and inverse plan optimization for highly conformal distributions.

Because the partial tolerance verification used to maximize the dose to the tumor while minimizing the dose to the surrounding tissues is included in 77301, you should not report it separately with 77331 (Special dosimetry [e.g., TLD, microdosimetry] [specify], only when prescribed by the treating physician) or 77370 (Special medical radiation physics consultation).

This service (77301) also includes generating required isodose curves, so you typically won’t be reimbursed for teletherapy codes 77305-77321 if you report them with 77301.

Report 77301 once per course of treatment.

Caution: Don’t report 77295 for IMRT plans that don’t meet the medical necessity to be reimbursed as IMRT, the OIG’s model compliance program warns. You also shouldn’t use 77295 for an IMRT boost.

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