New IMRT Codes Deliver Targeted Reimbursement
Published on Fri Nov 01, 2002
With a little help from savvy coders, oncology centers will be able to justify the serious investment in equipment and training that the popular new intensity-modulated radiation therapy (IMRT) requires. Two new planning and daily treatment codes 77301 (Intensity-modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) and 77418 (Intensity-modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session) are contributing to IMRT's fast track with radiation oncology facilities. IMRT promises to be superior to conventional radiation therapies when treating tumors that must be precisely targeted to protect surrounding tissues and structures.
"Everyone is getting it or installing it," says Jim Hugh, MHA, director of Atlanta-based AMAC, a coding and billing consulting firm, and author of several articles on IMRT reimbursement.
The simple message for oncology coders is that IMRT uses a computer optimization process to deliver a more precise radiation dose to the tumor while sparing the surrounding normal tissues, says Deborah I. Churchill, CPC, president and founder of Churchill Consulting Inc., an auditing and electronic coding consulting firm in Killingworth, Conn. Fuggeddabout Reporting 77301 With Other Treatment Planning CPT text describes IMRT planning code 77301 with great specificity. 77301 properly describes a permanent record of computer-generated inverse treatment plans, including 3-D tumor and critical structure volumes, inverse planning, dosimetric or biological objectives, dose-volume histograms and dose verification.
Because IMRT requires specialized hardware and planning software to provide inverse planning, 77301 is necessary to describe the work necessary to prepare for safe and effective treatment.
77301 entirely replaces any other planning code. From clinical standpoint, when planning IMRT for an entire cours of radiation therapy, there is usually no need to perform any other isodose planning, so it makes sense for the IMRT cod 77301 to limit the use of standard isodose planning codes 77305-77321, Churchill says. In addition, evidence of physician review must be available, and treatment centers will have to show extensive verification, experts say. 77301 Bundling Has One Slip Knot The CCI now states that for freestanding centers, 77301 is bundled in with several other codes, including daily and special treatment plans and special port plans. The followin procedures that are performed on the same day by the same provider are among the codes bundled with 77301: CAT scans 70450-70492; 71250-71270 Computed tomographic angiography 70496-7049 Three-dimensional plan 77295 (modifier -59 exempt [Distinct procedural service]) Physician treatment plan 77261-77263 (modifier -59 exempt) Special dosimetry planning 77331 (modifier -59 exempt) Treatment devices 77332-77334 Physics 77336-77370 (modifier -59 exempt) Special treatment procedures 77470 (modifier -59 exempt). [...]
