Radiology billing, Coding, Documentation, CPT codes, denial management, and Reimbursement.


CLINICAL TREATMENT PLANNING (EXTERNAL AND INTERNAL SOURCES)

The clinical treatment planning process is a complex service including interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures.

DEFINITIONS:

SIMPLE – planning requiring single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking.

INTERMEDIATE – planning requiring three or more converging ports, two separate treatment areas, multiple blocks, or special time dose constraints.

COMPLEX – planning requiring highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotational or special beam considerations, combination of therapeutic modalities.

Reimbursement for procedure codes 77261, 77262 & 77263 is for the global fee.

77261 Therapeutic radiology treatment planning; simple

77262 intermediate

77263 complex

DEFINITIONS:

SIMPLE – simulation of a single treatment area with either a single port or parallel opposed ports. Simple or no blocking.

INTERMEDIATE – simulation of three or more converging ports, two separate treatment areas, multiple blocks.

COMPLEX – simulation of tangential portals, three or more treatment areas, rotation or arc therapy, complex blocking, custom shielding
blocks, brachytherapy source verification, hyperthermia probe verification, any use of contrast materials.

Three-dimensional (3D) computer-generated 3D reconstruction of tumor volume and surrounding critical normal tissue structures from direct CT scans and/or MRI data in preparation for non-coplanar or coplanar therapy. The stimulation utilizes documented 3D beam’s eye view volume-dose displays of multiple or moving beams. Documentation with 3D volume reconstruction and dose distribution is required.

Simulation may be carried out on a dedicated simulator, a radiation therapy treatment unit, or diagnostic X-ray machine.

77280 Therapeutic radiology simulation-aided field setting; simple

77285 intermediate

77290 complex

77293 Respiratory motion management simulation (List separately in addition to code for primary procedure)

77299 Unlisted procedure, therapeutic radiology clinical treatment planning