Oncology & Hematology Coding Alert

Question: What level of supervision is needed for image-guided radiation therapy (IGRT)? Does it need a direct supervision?

New Mexico Subscriber

Answer: Per ASTRO and ACR guidelines for radiation oncology, IGRT now requires only direct supervision where previous to July 1, 2009, personal supervision was required Section 410.32(b)(3) of the Code of Federal Regulations defines this level of supervision as follows: (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 the oncologist is in the vicinity and immediately available in person if needed.

You can use 77421 (Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy) for imaging, localizing and correcting target volume location immediately prior to 3D or IMRT treatment delivery.   Ultrasound based systems use 76950 (Ultrasonic guidance for placement of radiation therapy fields) and CT based systems use 77014 (Computed tomography guidance for placement of radiation therapy fields).