Good Morning,
I was wondering If anyone would be able to help me understand how to read lap reports for the above CPT codes 77300 and 77334. Provider is billing 15 units of 77300 and 13 units of 77300. I am trying to identify how to see what would classify as one unit?
thanks,
Jenna
If you code radiation oncology regularly, I'd highly recommend getting access to the ASTRO Coding Resource book. Another good book is RCCS Navigator for Radiation Oncology. Both will help explain the codes for each stage in the process of care. There are also a lot of great webinars out there - AMAC has a bunch on its website:
https://amac-usa.com/index.php and RCCS also has education available - anything you can watch presented by Teri Bedard is worthwhile, IMO.
To answer your other questions:
77300
Basic radiation dosimetry (77330) is a mathematical computation of the radiation dose at a particular point.
Documentation of the dosimetry calculations should include the physician and physicist approval of the electronic or paper document showing the dose calculations. You should see some type of physics calc check document that shows each calculation. You'll see one unit per gantry angle or arc beam.
The MUE is 10, but it's a clinical date of service edit. If there is documentation to support it, more units can be allowable.
77334
77334 is for the design and construction of complex treatment devices. These could be irregular blocks, special shields, compensators, wedges, molds, or casts.
Immobilization devices keep the patient in a consistent position each treatments. To be billed as a complex device 77334, they must be specifically designed and customized for an individual patient. (If it is an immobilization device that can be reused for other patients, it would be simple 77332.) Examples of a complex immobilization device would be a thermoplastic mask molded to the patient's face to hold the head still during treatment. You might also see terms like alpha cradle or vac lock. (It really just depends on the type of treatment and what part of the body - most will require at least one immobilization device, but some body areas will require many more.)
Blocks and wedges are used to shape the treatment field to the tumor contour and avoid radiation exposure to normal tissues. You'd see documentation that there was some type of customized device for the patient.
Normally you'd charge separately for blocking for each field. However, per ASTRO's coding resource book, if 2 blocks are mirror images of each other and designed from the same treatment fiel (Ex - AP and PA blocks for parallel opposed beams the gantry rotates 180 degrees and the patient does not move.), you'd only charge for 1 unit for the professional component. The technical component would still be reported as 2 units for the materials used to created the block.
In the documentation, you might see a scale image/drawing of the block, or a written device design statement. The physician's signature should be on the documentation of the device.
Per ASTRO, in a typical course of radiation therapy, you might see 5-7 professional codes for devices. Prostate, head/neck, and other complex treatments may require up to 10 device codes including blocks and immobilization.
The MUE is 10, but it's a clinical date of service edit. If there is documentation to support it, more units can be allowable.
If you have any other questions or need additional clarification, please let me know!