Oncology & Hematology Coding Alert

Question: How should I report IMRT treatment planning and delivery for a head and neck cancer patient?

California Subscriber

Answer: When you-re coding IMRT for head and neck cancers, report 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) for the treatment planning.

For delivery, report 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session).

Your oncologist's documentation must of course support reporting these codes.

Pay attention: For compensator-based IMRT, you should report 0073T (Compensator-based beam modulation treatment delivery of inverse planned treatment using three or more high-resolution [milled or cast] compensator convergent beam modulated fields, per treatment session) along with 77301 for treatment planning.

Tip: Payers may cover IMRT for certain head and neck cancer diagnoses, including naso-pharyngeal carcinoma (such as 230.0, Carcinoma in situ of digestive organs; lip, oral cavity, and pharynx).

Benefit to patient: IMRT's conformal radiation planning and delivery target lesions better than standard techniques, limiting side effects (such as xerostomia) and sparing surrounding normal tissue.

You-re most likely to see your physician document IMRT with diagnoses including cancer of the tongue (141.x), oropharynx (146.x), and nasopharynx (147.x). Your oncologist may also use IMRT to treat a carcinoma in situ of the mouth or pharynx (230.0).