Compliance & Clinical Solutions

Radiation Therapy Billing FAQ: Part Two

A continuation of our Radiation Therapy Billing Series, focused on answering frequently asked billing questions.

This is the second post in our Radiation Therapy Billing FAQ Series. Billing is an essential function in radiation therapy departments but can be challenging for any clinician. Certain codes can be interpreted in various ways and insurance companies often have different acceptance criteria. To help alleviate anxiety around the topic, we’ve answered a few frequently asked questions. The information contained in these responses can be found  in greater detail through a variety of billing references, such as ASTRO and Coding Strategies.
 The opinions stated here reflect those of employees at Radformation based on coding experience and available resources. Radformation makes no formal recommendations on how departments execute their billing. Check with your local insurance payers before deciding on the appropriateness of coding for any procedure codes.
1. How does coding for VMAT plans differ from static field IMRT?
Intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) offer more conformal target coverage and normal tissue sparing compared to 2D and 3D planning and delivery. Even though IMRT and VMAT offer different approaches to treatment delivery, both can be considered equivalent when discussing coding and billing.

Only one IMRT plan (77301) can be billed per patient course of treatment, even if multiple plans exist as a result of boost plans,changes in field size, etc. However, if a new planning CT scan is acquired due to significant changes in patient or tumor anatomy, an additional IMRT plan may be appropriate if shown to be medically necessary. Sufficient documentation must exist if a new planning CT and IMRT plan is required.

The design and construction of the MLC device used for IMRT planning (77338) is billable once per IMRT plan. Even though IMRT plans contain multiple fields or arcs, the IMRT MLC is only billable as a quantity of one on the same date of service as the IMRT plan. However, additional units of the IMRT MLC may be billable for IMRT boost plans if approved and documented on different dates of service from the initial plan. The IMRT MLC should not be billed for compensator-based IMRT, where a complex treatment device (77334) is used to report the design and construction of the compensator.

Basic dosimetry calculations (77300) are billable with IMRT plans once for each static field or arc. If an IMRT field is too large for machine delivery and the carriage is split into additional fields, it is inappropriate to bill additional basic dosimetry calculations.


2. How are IMRT boost plans billed?
IMRT boost plans are typically approved and documented in one of two ways: (1) on the same date of service as the initial IMRT plan, or (2) on a subsequent day some time after the initial IMRT plan. Only one IMRT plan (77301) is allowable per course of treatment. Even if IMRT boost plans are approved and documented on a different date of service compared to the initial, additional plan charges are not allowable.

The number of basic dosimetry calculations (77300) does not differ based on the plan date of service. Since basic dosimetry calculations are billed once for each static field or arc, they are allowable if the boost plan is approved and documented on the same date of service as the initial plan or on a subsequent date of service. Whether or not an additional IMRT MLC (77338) is allowable depends on the approval and date of service of the boost plan. If approved and documented as a part of the initial plan, only a single IMRT MLC is billable. However, if the IMRT boost plan is approved and documented on a later date compared to the initial, an additional IMRT MLC along with all boost plan basic dosimetry calculations would be billable on the boost plan date of service.


3. Are verification simulations billable for IMRT plans?
The verification simulation process has shown to have significant clinical relevance. Performed prior to treatment, the patient returns to the department to verify the correct placement of treatment fields, linac clearance, patient position, and treatment devices. All verification simulations, regardless of the complexity, are reported using the simple simulation (77280) procedure code. However, verification simulations charges are not appropriate for IMRT courses of treatment, as reported by the 2020 Medicare National Correct Coding Policy Manual, even if performed fully prior to treatment.
We hope these short summaries help clarify some frequently asked questions or, at a minimum, confirm what you already know! Let us know if you have a question for future Radiation Therapy Billing FAQ posts.

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