Designing and 77332-77334

Pelham, AL
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I have a provider wanting to bill 77334. He stated that he is not designing the blocks, but approving them. Am I correct that he can't bill this CPT unless he personally designs it? I know about the other rules going along with this code, but I'm getting hung up on the word design in the code description. What exactly is required for the design component to be met by the provider?


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Reply - Designing and 77332-77334

Hello -

You don't mention what kind of dosimetry plan the device(s) are associated with (2D, 3D, IMRT).

The way that the image-based radiation treatment planning computers work, is the "design" is derived from the treatment volume that is established during the physician's contouring (outlining) of the treatment volume, normal and critical structures. The dosimetry plan will have "beams-eye view" images that demonstrate the end product - the beam shape or "design" for that gantry angle. The physician then has the option of modifying this "design", based on their knowledge of the tumor and nearby anatomy. It is also just as likely the physician will approve the design, based on their initial input of tumor and critical organ/structure volumes. If you have access to the dosimetrist at the center you are coding for, they can demonstrate this for you.

Unless the "design" is very basic - for example an electron cut-out on the skin surface, the physician usually is not drawing a "beam-shape" any more. That technology has been surpassed by (usually) CT scan image reconstruction, even for relatively simple planning. IMRT "design" is much different. Not going to go into that now. :)
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