Section 8Section 8

Radiation Oncology Radiation Oncology Dosimetry CPT Codes Dosimetry CPT Codes

77300 - 7737077300 - 77370

Modified For 04-10-1481

031314

3:15 to 4:00 PM Section #8

Susan VannoniSusan Vannoni

77300 Basic Radiation Dosimetry 77300 Basic Radiation Dosimetry CalculationCalculation..

This procedure may be billed any This procedure may be billed any time during a course of radiation time during a course of radiation therapy, andtherapy, and as many times as as many times as necessary.necessary.

Basic Dosimetry Calculations

(External Beam) 77300

2

77300 IS A GLOBAL BILLING CODE77300 IS A GLOBAL BILLING CODE

Occurrence Rate 2013

77300 4.01 per case, conventional treatment 77300 1.31 Electron treatment 77300 5.38 per case, all modalities 77300 6.05 per case IMRT (did not change with

switch to use of 77338) The averages is about 1.58 Dosimetries per

conventional block, 77334, and 1.01 per 77338 for IMRT.

These ratios are lower for 2013 due to a drop in the average number of IMRT beams being used per case.

3

Only one 77300 may be Only one 77300 may be charged for the required charged for the required two independent means two independent means of calculating the basic of calculating the basic

dosimetry.dosimetry.

Computer Versus “Hand” Calculations

3

Computer calculations (Varis/Aria)

NIB

MU CHECK IS COMPUTER GENERATED, BUT IS CONSIDERED A SECOND (HAND) DOSE

CALCULATION

5

• Documentation in the medical record must include an explanation of the need for multiple basic dosimetry calculation .

• Each calculation should be identified specifically as to its necessity, i.e., central axis depth dose, critical organ dose, off-axis dose, abutting fields, etc. This statement may need to be on the comment line of the HCFA 1500 form for payment by Medicare

• ONLY ITEMS USED CLINICALLY MAY BE BILLED

Documentation Requirements

9

Basic Dosimetry Calculations 77300

What’s it for?Any calculation performed that constitutes a component of the Dosimetry Record, monitor unit calcs (MU), decay calcs, off axis factors, etc.

Who normally documents/bills/captures this codes?Dosimetry, Physicist or Therapists.

When is this codes normally billed?This code can occur almost any time during the course of therapy

What Documentation is suggested for this code?The calculation itself, signed by the physician, and Dosimetry.

What are the common documentation errors identified with this code?Not having a physician’s order and, not being signed by the physician

What are the common billing errors?Missing individual calculations due to not recognizing dosimetry documentation.

20/150

9

There is no longer any billing There is no longer any billing allowed for the treatment planning allowed for the treatment planning CT 77014, as this code has been CT 77014, as this code has been retired. The CT procedure is done retired. The CT procedure is done as part of the planning process.as part of the planning process. If a full diagnostic CT scan is done, If a full diagnostic CT scan is done, this may be billed as a diagnostic this may be billed as a diagnostic procedure if it has been read by a procedure if it has been read by a diagnostic radiologist.diagnostic radiologist.

11Treatment Planning CT Scan and Isodose plans

Isodose planning is based upon data Isodose planning is based upon data from CT scansfrom CT scans

Teletherapy Isodose Plan(s)

77305 - Simple Isodose Plan77310 - Intermediate Isodose Plan77315 - Complex Isodose Plan

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77305 – 77315 ARE GLOBAL BILLING CODES77305 – 77315 ARE GLOBAL BILLING CODES

COLOR WASH DOSE PATTERN Hot, red, colors are higher dose, with blue and green lower dose

ISODOSE DOSE LINE PATTERN, each line indicates a boundary of dose, graduating out from the central highest dose

TWO FORMATS OF ISODOSE DISPLAY 15

Teletherapy isodose plans developed through the use of

IMRT, or three dimensional techniques are to be reported as part of the codes 77295, or 77301 and not to be billed and not to be billed

separately as 77315.separately as 77315.

16

Clinical ChangesClinical Changes

Clinical variations of the patient during therapy may necessitate a new plan being made and reported.

The radiation oncologist must document the reasons for the rendering of an additional isodose plan.

16

Documentation maintained in the patient’s medical record must include an explanation of the need for both the initial as well as any subsequent isodose plan.

Documentation Documentation RequirementsRequirements

16

Isodose Dosimetry 77305- 77315

What’s it for? Isodose Dosimetry is a representation of dose formed by a confluence of one or more treatment beams on an area of interest.

Who normally captures these codes?Dosimetry or Physicist.

When are these codes normally billed?Upfront, after Simulation, and later in the course of therapy with reduced fields.

What Documentation is suggested for these codes?The plan must be signed by the physician, and a Planning note is advised to more fully document the procedure.

What are the common documentation errors?These are normally documented quite well with very few errors. The most common problem is the lack of a clear physician’s order for the plan.

What are the common billing errors identified?Observe rules; 0nly one Isodose Plans on a given date, do not Bill this service with 3-D or IMRT.

17

Special Beam Plan Special Beam Plan 7732177321

• This code is to be utilized when a treatment decision for any special beam consideration is required, such as the use of electrons, heavy particle beams or other nuclear beams.

• The use of electrons as a portion of, or as the sole modality for the treatment of a particular problem is the most common use of this code.

18

77321 IS A GLOBAL BILLING CODE

Isodose Plan may be Needed for Electron Treatment

IB

77315

77321

21

Electron boost port

77321

22

Post operative Parotid tumor

Electron boost to breastElectron boost to breast

23

Typical basal

cell carcinoma of the

tip of the nose

treated with

electrons

23

Coding Guidelines

Electrons 77321

• This special beam consideration code is to be billed only one time for the course of treatment.

• We recommend that it be billed on the first day of clinical use to treat the patient.

• This special beam is billed as daily treatment delivery with the code based on the maximum energy of the treatment machine, not related the electron energy utilized for treatment

24

A specific report is not required by Medicare, however it will help in the documentation and

justification of electron usage (RAC 2011)ONCOCHART

24

Special Beam 77321

What’s it for?The use of a particulate beam in the treatment of a patient, such as electrons, protons, or neutrons.

Who normally captures this code?Dosimetry, Physics or the Treating Therapist.

When is this code normally billed? The first day of particulate beam therapy being delivered.

What Documentation is suggested for this code?The use of electrons, protons, or neutrons in treatment.

What are the common documentation errors with this code?Not following your LMRP/LCD rules on this code.

What are the common billing errors identified?Not knowing the CCI rules, billing with edited 773xx codes.Not recognizing that the particulate beam was used.

24

SPECIAL DOSIMETRY

77331 - Special/Microdosimetry

Special/microdosimetry consists of the use of special radiation measuring and monitoring devices for determining the specific dosage of radiation at a given point.

25

77331 IS A GLOBAL BILLING CODE

• This code covers the use of thermoluminescent dosimeters, solid state diode probes, special dosimetry probes, film dosimetry, or other methods for measuring the specific dosage at a given point.

• These procedures must be done at the direct request of the radiation oncologist.

• Medical necessity must be documented in the chart. This code may be reported for each specific location of measurement.

25

Narrative Microdosimetry report 77331 28

Special Dosimetry Special Dosimetry 7733177331

What’s it for?The use of Diodes, TLDs, and other beam measuring devices

Who normally captures this code?Treatment Therapist and/or Physicist.

When is this code normally billed?Within the first few fractions of any new field being treated.

What Documentation is suggested for this code?A Physics/Physician report documenting the measurement, and any actions to be taken as a result of the readings.

What are the common documentation errors identified with this code?Not being signed by the physician or physics.Not having a specific physician’s order for the procedure.Failure to establish medical necessity for the procedure

What are the common billing errors?Not understanding what a diode is, how it is performed, and where it is documented. Failure to observe CCI edits with other 773XX codes.

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TREATMENT DEVICES

30

CPT Codes

7733277332 - - Treatment Devices; SimpleTreatment Devices; Simple77333 - Treatment Devices; 77333 - Treatment Devices; IntermediateIntermediate77334 - Treatment Devices; Complex77334 - Treatment Devices; Complex77338 – IMRT Single Block Charge77338 – IMRT Single Block Charge

30

77332 -77334, 77338 ARE GLOBAL BILLING CODES77332 -77334, 77338 ARE GLOBAL BILLING CODES

Occurrence Rate, Occurrence Rate, Blocks 2014Blocks 2014

77332 is <2% occurrence rate 77333 is <1% occurrence rate 77334 is 98% occurrence rate Immobilization devices account

for 27% of 77334, about 1.64 per case.

30

77332 Simple Treatment Devices Treatment Devices, design, Treatment Devices, design,

construction or selection; Simple construction or selection; Simple (single block, single bolus) (single block, single bolus)

Usually no special fabrication is Usually no special fabrication is necessary for these blocks; pre-necessary for these blocks; pre-made blocks may be used. made blocks may be used.

36

Simple Treatment BlockSimple Treatment Block 36

80/150

BolusBolus• The use of bolus usually constitutes a simple

device.

• It is a rare situation where a simple bolus is the only treatment device used.

• If some other treatment device is used, the most complex of these will drive the level of complexity for that port.

• A simple bolus used with a complex device A simple bolus used with a complex device will cause the charge to be driven to the will cause the charge to be driven to the

higher level of complexity 77334. higher level of complexity 77334. You may You may not charge for the bolus.not charge for the bolus.

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85/150

77333 Intermediate Treatment Devices

Treatment Devices, design, construction or selection; Intermediate (more than one area of port blocked - blocks, stints, bite blocks, special bolus)

39

• The most common The most common intermediate treatment intermediate treatment device will be simple device will be simple blocking, but covering blocking, but covering multiple areas of the port.multiple areas of the port.

• Simple blocking covering two Simple blocking covering two different areas, such as different areas, such as multiple bone metastasis is multiple bone metastasis is considered intermediateconsidered intermediate

39

A pre-fabricated stint used to A pre-fabricated stint used to modify a patient’s anatomy for modify a patient’s anatomy for the proper delivery of a the proper delivery of a radiation dose is billed as an radiation dose is billed as an intermediate treatment device. intermediate treatment device. A custom stint is a complex A custom stint is a complex device (ACRdevice (ACR, 2001), 2001)

Stints

40

Custom Stint 7733440

A custom stint is being used to distance the electron treatment port away from

the underlying gum

40

BILL AS77334

MULTIPLE SIMPLE

SKIN LESIONS

41

This case has 3 or more sites;Treatment planning is complex 77263Simulation (clinical simulation) is complex 77290Blocks, treatment devices, are each simple, 77332 X 3Dosimetry is done for each port, 77300 X 3

1= Simple2= Intermediate3+= Complex

77334 Complex Treatment Devices

41

Complex treatment device42

This procedure must be planned in the same comprehensive and complex fashion as custom field blocking and is reported as 77334.

Multi-leaf or Dynamic Collimation (MLC)

42

In the case of IMRT treatment, each portal may use MLC custom shaped blocking,

For Medicare, all government insurance, and most private insurance, MLC must be reported as IMRT beam modifier, 77338.Compensator IMRT is still 77334

Blocking for IMRT 7733842

Eye Shields 77334 An eye shield is a complex multi-use device.

43

Its application is highly complex and

precise. The radiation

Oncologist must clinically place this

eye shield with each treatment.

43

Treatment devices may be used for Treatment devices may be used for patient immobilization to patient immobilization to accurately reproduce the set up on accurately reproduce the set up on a daily basis.a daily basis.

These devices are fabricated These devices are fabricated under the direct supervision of under the direct supervision of a physician and are specifically a physician and are specifically designed for an individual designed for an individual patient’s treatment course.patient’s treatment course. (ACR, 2001)(ACR, 2001)

Immobilization DevicesImmobilization Devices47

Vacuum Bags 77334

Each vacuum bag is utilized only for a single patient throughout the entire course of therapy.

47Bead filled vacuum bags are complex

multi-use devices.

Breast Board47

BILL ASBILL AS7733277332

According to the ACR/ASTRO Code Utilization & Application Subcommittee, the multiple setting breast board is now considered as a simple treatment device.

This opinion represents a consensus of coding practices from around the country, but does not constitute permission or prohibition for a given billing practice.

47

• A compensator is a device that will shape A compensator is a device that will shape the profile of the beam to compensate for the profile of the beam to compensate for uneven patient contours across the flat uneven patient contours across the flat face of the treatment port to even out the face of the treatment port to even out the dosage to the treatment area.dosage to the treatment area.

• The most common use of a compensator The most common use of a compensator will be to compensate for the steep slope will be to compensate for the steep slope of the chest wall.of the chest wall.

• A compensator, if custom designed A compensator, if custom designed for a particular situation, may be for a particular situation, may be billed individually and in addition to billed individually and in addition to other complex treatment devices.other complex treatment devices.

COMPENSATORCOMPENSATOR49

REGARDLESS OF REGARDLESS OF COMPLEXITY OF COMPLEXITY OF

DESIGN OR USE, ALL DESIGN OR USE, ALL COMPENSATORS WILL COMPENSATORS WILL BE BILLED AS 77334BE BILLED AS 77334

49

CUSTOM COMPENSATORCUSTOM COMPENSATORFOR TOTAL BODY TREATMENT 77334FOR TOTAL BODY TREATMENT 77334

50

Proton Tissue compensatorProton Tissue compensator 7733477334

50

Milled brass proton beam shaping compensator77334

NIB

IMRT COMPENSATOR 77334

NIB

Square tissue compensator to evenly distribute the dose over the tumor volume. Complex compensator, 77334, in addition to the mask, 77334

50

Rice bolus

Tumor volume

This is the patient 6 months after completion of radiation therapy to the

scalp lesion.

50

When cast compensators are When cast compensators are utilized for IMRT blocking.utilized for IMRT blocking.

Each block or fluence is billed as Each block or fluence is billed as 7733477334

Note; this is still the same as in Note; this is still the same as in previous years, do not use the previous years, do not use the

single 77338 code for single 77338 code for compensator blocking compensator blocking

IMRT Compensator BlockingIMRT Compensator Blocking 51

Regardless of the complexity or design of the conventional therapy conventional therapy

treatment devicetreatment device, some form of narrative may be required

52

Device report for two immobilization devices, each of these will be billed as 77334,

complex device.

52

WHEN TO BILL TREATMENT DEVICESWHEN TO BILL TREATMENT DEVICES

Date of DESIGN of device Date of CREATION of

device Date of USEUSE of device

53

Treatment DevicesWhat are they for?

Blocking (cast or MLC) wedges, compensators, Brachytherapy devices.Who normally documents/bills/captures these codes?

Dosimetry, Treatment or Simulator Therapist, physics or physician. When are these codes normally billed?

They can occur anytime in the course of therapy. What Documentation is suggested for these codes?

The design on DRRs for a block. A written report may be generated if required by your insurance carriers. Photographs are useful.

What are the common documentation errors with these codes?Insufficient documentation to support the use of the device.Lack of Physician statement of medical necessity.

What are the common billing errors identified?Not understanding the specific rules of CCI and MUE editsNot understanding which device is immobilization and which is blocking.Not knowing that professional and technical rules are different.Not recognizing that the procedure was performed.

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SP134/150

Special Physics CPT Codes

77336 - Continuing Medical Physics Services

77370 - Special Medical Physics Consult

55

Special Physics Codes

The two special physics codes 77336 and 77370 are considered as technical services only.

The physician may not bill for these procedures, however the physician is legally responsible for all physics procedures performed in his department.

55

77336 Continuing Medical Radiation Physics

The safe use of radiation requires the continuing medical physics services to ensure that the treatment being delivered conforms precisely to the physician’s intent and prescription from a technical (medical physics) point of view.

These services are typically described using 77336 and are distinctly provided by the medical physicist for each patient.

These services are provided by or under the supervision of a qualified medical physicist.

55

77336

• 77336 was devised many years ago to account for a general, single reimbursement value per week covering a multitude of relatively small physics services that are performed for each patient undergoing treatment

• These are not to be considered as quality control features but, are essential to assure the accuracy and safety of the radiation treatment as it is being delivered in an ongoing fashion hence, the name Continuing Medical Radiation Physics in support of the therapeutic radiologist.

55

Patient Services covered bythe radiological physics code

77336• Weekly checking of the patient’s treatment record

• Confirmation of the proper mathematics related to daily chart entry

• Verification of the accuracy of the dose calculations

• Accuracy of daily entry in the treatment log relative to the physician’s prescription

• Proper utilization of the various treatment aids

• Assurance of the accuracy of treatment device design

• Translation of computer generated data to the daily treatment log pages

• Assurance that the physician’s prescription is being followed exactly

56

The tasks provided by the physicist are The tasks provided by the physicist are essential in ensuring that the physician’s essential in ensuring that the physician’s prescription is being followed accurately prescription is being followed accurately during the course of radiation therapy.during the course of radiation therapy.

Documentation of physics services Documentation of physics services performed is essential.performed is essential.

These services (77336) are not considered These services (77336) are not considered as special physics calculations (77370) and as special physics calculations (77370) and are not to be billed as such. (ACR, 2001)are not to be billed as such. (ACR, 2001)

77336

56

IMRT weekly physics report 77336

57

CONTINUING PHYSICS WITH CONTINUING PHYSICS WITH BRACHYTHERAPYBRACHYTHERAPY

Multiple procedures may be performed and billed by the physicist for his work related to a course of Brachytherapy.

Most of these procedures are covered under the continuing physics code 77336 or a special physics consultation 77370.

See the list on page 60.

58

Continuing physics report, 77336, for Brachytherapy

59

Continuing Medical Physics 77336

What’s it for?The Medical Physicist weekly involvement in insuring proper patient treatment.

Who normally documents this code?The Physicist.

When is this code normally billed?Weekly (every 5 fractions) during a course of therapy.

What Documentation is suggested for this code?A worksheet or electronic document showing that the Medical Physicist has reviewed the week’s treatment.

What are the common documentation errors with this code?Inadequately documenting services rendered.

What are the common billing errors identified?This code can be billed any time during the course of the five fractions. Know the many CCI edits against this code . This is a technical only code, never bill a professional component.

59

7737077370 Special Medical Radiation Physics Special Medical Radiation Physics ConsultationConsultation

This code is used in a consultative situation describing a very specific procedure that is carried out by the medical radiological physicist at the direct request of the radiation oncologist.

This code describes a special situations requiring the expertise of the medical radiological physicist to completely analyze a problem and develop a summary for the radiation oncologist.

The physicist must render a special written report to the radiation oncologist.

60

Computerized physician order [CPO] requesting a physics consultation. This consultation will ultimately be billed as a 77370 special physics consult. A direct request by the physician for this procedure is required.

60

7737077370

This procedure is performed to directly benefit an individual patient, and is patient specific and distinctly different from the broader multi-patient issues addressed by the Code 77336.

The radiation oncologist will be expected to analyze and sign off on the report. The findings may be used to design or modify the treatment situation under analysis.

60

Special Physics Consult

A review of the previous port films from Baptist Hospital show the port extended to the mid-portion of the body of C-7.

Recommendation: A central axis beam splitting upper edge of the treatment port will allow close abutment of the port covering T-1 with the previous field at C-7. Calculations of the gap will require 1.3cm on the skin resulting in beam crossing below the level of the spinal cord.

NSD decay of the 3000 rads delivered to the previous field would indicate, at maximum, a 10% reduction in equivalent dosage however, if the ports are properly set, there should be no additive effect between the two portals.

Physicist Physician

The Right Doctors – The Right Technology230 North Midwest Boulevard – Midwest City, OK 73110 – (405) 737-8455

61

Some of the recent edits of Medicare will not allow any other 77300 series code to be billed on the same date as 77336 or 77370.

These codes should be reported on separate dates, and cannot be billed together.

77336 can be reported any time within the 5-day period of a week of therapy. Check your LCD

62

• The technical component of 77336 and 77370 codes recognizes the efforts of the physicist, dosimetrist, and auxiliary personnel.

• No professional charges will be made for these services by the Physician, medical radiation physicist or dosimetrist.

63

Medicare assumes that a physics assessment (77336) is reported once for every week (five fractions) of external beam treatment.

For other forms of radiation therapy that do not adhere to the five-fraction/week rule (e.g. brachytherapy, stereotactic), code 77336 may be reported as medically necessary and supported by documentation.

A special physics consult (77370) is typically required only once per course of radiation therapy.

63

Special Medical Physics Consultations 77370

What’s it for?This is a requested consultation, and it should be documented as answering a difficult question on a specific patient.

Who normally captures this code?Medical Physicist.

When is this codes normally billed?Once per treatment course at any time

What Documentation is suggested for this code?A narrative type document by the physicist explaining the physics problem being requested by the physician.

What are the common documentation errors identified with this code?A Special Physics Consult must be performed, and must be documented in the medical record to bill the service. Medical necessity must be evident.

What are the common billing errors identified?Multiple CCI edits exist against 77370, almost all 773xx codes are edited against it.

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150/150

PRINCIPLES OF BILLING, CODING AND

COMPLIANCE IN RADIATION ONCOLOGY

BMSi 2014End sect 8

END OF SECTION 8 8

NEW PROGRAM FORMATNEW PROGRAM FORMAT

Dr. Bogardus will not be here in person, but he will be available and participating using a live video simulcast from the BMSi office in Oklahoma City.

This is a live two way communication, and the audience is encouraged to interact as we have always done in

the past.

Bolus Buildup Simple device

40

PRE MADE CAST ELECTRON BLOCKSPRE MADE CAST ELECTRON BLOCKS

77332 SIMPLE GENERIC DEVICES77332 SIMPLE GENERIC DEVICES

NIB

DIODE PROBE

26

MOSFET MOSFET SOLID STATE SOLID STATE DOSIMETERDOSIMETER

SINGLE USE DEVICE77331

27

IMPLANTABLE IMPLANTABLE TRANSPONDER MOSFET TRANSPONDER MOSFET

DOSIMETERDOSIMETER Single use implantable dosimeter coupled

with a telemetric passive transponder Capable of recording cumulative daily dose Approved for use in prostate Generally two are implanted Urology code 55876 for implantation

Medicare professional $108.77 (2008)

Hospital code A4649Medicare technical ~ $1,200.00

27

Antenna

Passive solid State circuit

Mosfet

Hand heldwand

Reader circuit

27

77421 77421 Stereoscopic localization, report daily

for IGRT

7733177331 Special

Dosimetry, can report cumulative dose, per dosimeter

EACH OF THESE PROCEDURES REQUIRES A SEPARATE REPORTEACH OF THESE PROCEDURES REQUIRES A SEPARATE REPORT

27

Mosfet implanted dosimeter/marker report for micro

dosimetry

Two versions of

report, narrative and brief

28

Record and Verify Systems are not reportable as 77331.

Record and verify is part of standard quality assurance and carries no reimbursable component.

29

77331 is not appropriate, and could not be reasonably defended, for a room survey following Brachytherapy.

60/150

Electrons

The characteristics of electrons are such that a higher level of care of the patient, special attention by the treatment machine personnel, and an extensive knowledge of the physics and interaction of electrons with tissue, is required of all personnel.

19

35/150

Electrons may enable the radiation oncologist to re-treat an area that has previously been heavily irradiated.

Electrons are most often used as a boost to an area that is either receiving or has received a separate photon beam in addition to the electrons.

If the center does not have a KV unit, then Electrons may be the best modality for treating small primary skin malignancies or skin metastasis.

The use of Electrons

22

77334A wedge is a device that shapes the profile of

the treatment beam to

compensate for an

angular plane of

entry

Standard Machine Wedge

45

The most common immobilization device in 1970 was 3-M masking

tape

NIB

Can I bill for the tape as a complex treatment device?

NIB

Rectal balloon prostateRectal balloon prostate immobilization deviceimmobilization device

This is a customizable complex immobilization This is a customizable complex immobilization device, device, but it cannot be billed daily by the but it cannot be billed daily by the

physicianphysician for each new device usedfor each new device used. Hospitals . Hospitals may be able to bill a supply code daily for the may be able to bill a supply code daily for the

device. Some physicians are generating a device. Some physicians are generating a comprehensive 5 day report and billing the comprehensive 5 day report and billing the use of these devices (77334) on a weekly use of these devices (77334) on a weekly

basisbasis

NIBInflation device

Inflatable balloon Vent

Depth gauge

Adjustable depth stop

Typical narrative report for the daily use of rectal balloon prostate immobilization devices, bill as 77334 one time every 5 uses, documentation required, may not may not be paid by Medicare, CHECK YOUR be paid by Medicare, CHECK YOUR

LCDLCD

NIB

Aquaplast Face Mask77334

50

119/150

ACCUFORM IMMOBILIZATION DEVICE

BILL AS 77334 in addition to the Aquaplast face mask

51

For private pay or commercial insurance plans, the code 77334 per

fluence may still be valid. Basic Dosimetry 77300 may still be billed one per fluence. CHECK YOUR LCDCHECK YOUR LCD

43

Conventional Treatment

Compensator77334 documented by a physics report

52

For Medicare and most insurance, you must report IMRT blocking as 77338, one time per IMRT treatment plantreatment plan, the basic Dosimetry 77300 may still be billed per

fluence

44

CCN Page 211 – Figure 12.33A 2002

Alpha Cradle77334

49

Multiple complex treatment devicesMultiple complex treatment devices

47

107/150

Custom Immobilization DeviceNIB

Fixation/Immobilization device fabricated to separate the tongue from a lesion in the

palate

77334

Tumor volumeDeviceTongue

Continuing Quality Assurance

•Machine calibration (usually done monthly)

• Interlock checks (usually done monthly)

•Source verification (usually done weekly or monthly)

•General radiation safety issues

58

This report may be billed as a special physics consultation 77370

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