Oncology & Hematology Coding Alert

Scenario: A patient with nasopharyngeal cancer is treated with IMRT to protect the parotid and other salivary glands and the optic nerves. There are five gantry angles, and the treatment occurs over six weeks. The following codes may be legitimate and reportable events in treating this patient: Consultation 99245 Complex therapeutic radiology treatment planning 77263 Pre-CT simulation with complex immobilization (on a different day than 77301) 77290 Custom immobilization; custom shielding per field setting; dynamic wedge per volume 77334 (Treatment devices, design and construction; complex) CT for treatment planning 76370 (TC only) IMRT planning 77301 Phantom irradiation on calibrated film to sample dose distribution (or equivalent testing system) 77331 (Special dosimetry) Therapeutic radiology simulation-aided field setting; complex 77290 Orthogonal films per week 77417 (Therapeutic radiology port film[s]) (6) Basic radiation dosimetry calculation 77300 (5) IMRT delivery 77418 (30) Continuing medical physics consultation 77336 (6) Weekly treatment management 77427 (6) Special treatment procedure 77470 Special medical radiation physics consultation, if ordered and documented 77370. The rule as always, Churchill says, is document, document, document. Be sure that the medical record clearly reflects every step of the process and that the patient record contains a note for both simulation procedures (77290).