Oncology & Hematology Coding Alert

Question: Can more than one special medical physics consult, 77370 (special medical radiation physics consultation), be performed during a patients course of treatment?

New York Subscriber

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Answer: Generally 77370 is billed once per course of therapy for the additional work performed by the physics staff. There are exceptions to this practice but they are rare, such as when two different modalities external beam followed by brachytherapy are involved in the treatment of a patient.

Code 77370 should be used for consultative purposes when a unique problem or special situation arises during radiation therapy. It requires a detailed written report describing the problem to be given to the requesting physician.

The physician, with a small explanation outlining why the request is made, must ask for the special physics consult in writing. Then the physicist will respond back to the doctor with a technical narrative explaining the information in physics terms. The physicist and the physician should sign this document.

It is important to note that 77370 is considered a technical-service-only code. It carries no physician component and is billed exclusively by the institution delivering the treatment. It is payable by Medicare Part B only in settings where the doctors office contains the equipment and staff to complete the consultation, such as a freestanding radiation oncology center that employs its own radiation physicist.

For example, 77370 would commonly be used in cases when the radiation oncologist notices an abnormality during his or her weekly review of port films. He or she would request the consultation of a physicist. If the physicist provides services that fall outside the routine assessment of treatment parameters, quality assurance of dose delivery and review of patient treatment documentation, 77370 should be used. Also, if the patient is undergoing total body irradiation, stereotactic radiosurgery, the code, can be billed by the facility that employs the physicist.