February 11, 2020
Radiation Therapy Billing FAQ: Part One
This is the first post in our Radiation Therapy Billing FAQ Series. Billing is an essential function in radiation therapy departments but can be challenging for any clinician. Certain codes can be interpreted in various ways and insurance companies often have different acceptance criteria. To help alleviate anxiety around the topic, we’ve answered a few frequently asked questions. The information contained in these responses can be found  in greater detail through a variety of billing references, such as ASTRO and Coding Strategies.
The opinions stated here reflect those of employees at Radformation based on coding experience and available resources. Radformation makes no formal recommendations on how departments execute their billing. Check with your local insurance payers before deciding on the appropriateness of coding for any procedure codes.

1. What is required when billing a 3D conformal radiotherapy plan?

A 3D conformal radiotherapy plan (77295) utilizes a computer-generated treatment plan to deliver a conformal radiation dose to a target or volume of interest. A CT scan is used to create a 3D tumor volume or volume of interest and surrounding normal tissue structures. The number of normal tissue structures required may vary depending on the insurance payer, but typically two to three structures is common in most plans. Plan analysis and documentation involves utilizing beam’s eye views, a dose-volume histogram (DVH), and 3D dose clouds and dose-volume displays of all three anatomical planes. What makes a 3D conformal radiotherapy plan unique from teletherapy isodose plans is it conforms the prescribed dose to the target or volume of interest while limiting dose to nearby normal tissue structures.

2. When should a special medical physics consultation be billed?

A special medical physics consultation (77370) starts when a radiation oncologist requests a report by a qualified medical physicist for an individual patient due to treatment plan complexity. When requested by the radiation oncologist, the expertise of the qualified medical physicist is utilized to investigate a specific problem. Following the investigation, the qualified medical physicist generates a written analysis for the radiation oncologist to review. The outcome of the physics report will guide the radiation oncologist in choosing whether to adjust the approach of the treatment plan or not. Special situations that may require a special medical physics consultation include, but are not limited to, the review and analysis of previous radiation treatment and assessment of cumulative radiation doses to normal tissue structures, calculation of dose to the fetus of a pregnant patient receiving radiation therapy, or treating multiple cancer sites simultaneously with overlapping fields. While IMRT QA is a necessary and required part of IMRT planning, reimbursement for the plan QA is a part of the IMRT planning charge (77301). IMRT QA should not be separately billed as a special medical physics consultation. Documentation of the radiation oncologist’s request, the physics report, and radiation oncologist review of the report are required for the special medical physics consultation.

3. Should a 4DCT be billed with a deep inspiration breath hold (DIBH) breast plan?

Respiratory motion management simulation (+77293) is performed when requested by a radiation oncologist to account for breathing-related motion of lung or abdominal tumors being targeted with radiation. Commonly referred to as a 4DCT, this procedure involves acquiring additional CT images during the full breathing range of the patient while using external fiducials or respiratory bellows to track breathing motion. Using the CT images acquired over the entire respiratory cycle, the radiation oncologist contours the moving tumor volume to account for the breathing-related motion of the tumor, resulting in a composite ITV. Even though the 4DCT images are acquired at the time of simulation, this add-on code is billed on the same date of service with either a 3D conformal radiotherapy plan (77295) or IMRT planning (77301), even though the work involved may take place over many days. While a DIBH breast simulation typically involves acquiring a free-breathing and a breath-hold CT scan, these scans do not include the full respiration motion. Therefore, a respiratory motion management simulation (+77293) charge would not be reportable with DIBH breast plans.
We hope these short summaries help clarify some frequently asked questions or, at a minimum, confirm what you already know! Let us know if you have a question for next month’s Radiation Therapy Billing FAQ.

written by Tyler Blackwell

Tyler is a board certified medical physicist with extensive clinical experience in radiation therapy. He is active in several AAPM committees, has served as secretary-treasurer for the Northwest Chapter of AAPM, and is an ABR orals examiner. Tyler dabbles in real estate investing and loves preparing breakfast for his two kiddos.

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