Oncology & Hematology Coding Alert

Question: Is 77321 appropriate for all electron services?

California Subscriber

Answer: Not all electron services merit 77321 (Special teletherapy port plan, particles, hemibody, total body).

Special teletherapy port plans often are electron plans because electrons require a high level of care, but there are certain "routine" electron fields that payers won't consider worthy of the "special" 77321 code. For example, you may find breast cancer electron boosts or lymph node treatments don't meet the stringent requirements.

Documentation also may show that rather than an electron isodose plan, you have only an electron calculation. In that case, you should report 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) and should not report 77321.

If you do have an electron isodose plan and are considering 77321, be sure documentation clearly shows medical necessity and the radiation oncologist's direct participation in ordering, calibrating, and anyother services required for the special teletherapy port plan.

Plus: Most payers also require a printed plan signed by the physician and physicist.