The following information appeared in Churchill Consulting, Inc.''''s CHURCHILL UPDATE Newsletter, AprilMay 2003 Volume # 22003, Issue 44

REPORTING 77300 with IMRT:

As a result of the ACR/ASTRO Joint Economics Committee efforts, the Centers for Medicare and Medicaid Services will delete the correct coding initiative edit that bundles IMRT planning CPT® code 77301 with the dosimetry calculation CPT® code 77300. CMS will make retroactive payments for any claims denied based on this CCI edit. The Joint Economics Committee has been working on this effort for several months and is pleased to have the physics calculations recognized for separate payment.

The deletion will appear in CCI version 9.2 scheduled for implementation on July 1, 2003 and payments will be retroactive to the date when this edit was developed April 1, 2002. Therefore after July 1, 2003 any claims that were denied based on this edit may be resubmitted for payment. Please contact your local Medicare carrier for more details regarding claims resubmission.

DOCUMENTING 77300 for IMRT. Although the above ruling does provide for reimbursement for the basic dosimetry code 77300 when performing IMRT, all work must be clearly ordered and documented in the medical record. When performing IMRT you cannot calculate an actual monitor unit at the central axis by a hand calculation due to the inverse planning performed by the computer. The computer accounts for the fact that many tiny pencilthin beams project to a nominal 1 cm or less at the treatment unit isocenter as well as multileaf collimator MLC that are used to cover the prescribed tumor volume.

When performing audits we have encountered situations where the organization automatically reported a basic dosimetry for each monitor unit that the IMRT computer plan generated, but they did not have any corresponding calculations available in the medical record. You may only report work that is ordered and subsequently performed.

There are multiple software applications that are available that can perform a validation calculation. CCI is most familiar with the RadCalc® application that includes an IMRT Validation Utility that provides the verification of MU or point dose calculations for IMRT based treatment plans. The IMRT utility allows you to import from your treatment planning system either static or dynamic MLC leaf sequences.

A dedicated calculation must be available in the medical record for each basic dosimetry code that is reported. For example, if you have a 6 portal arrangement you can report 6 basic dosimetry 77300 calculations, providing that you have evidence of the calculation confirmations in the medical record. Be sure that the physician orders the dosimetry and signs and dates the calculations.

The reimbursement for this code alone is significant. A standard IMRT case may have approximately 6 portals. The unadjusted reimbursement rate for code 77300 x 6 is demonstrated below:

Reimbursement	Rate	Total x 6
APC	$84.39	$506.54
Technical Medicare	$51.14	$306.83
Professional Medicare	$31.64	$189.94
Global Medicare	$82.78	$496.67

As demonstrated above, the basic dosimetry reimbursement alone will have a major impact on your collections. If you are performing IMRT and don''''t have a computation tool, it is recommended that you consider adding this purchase to your budget. Confirming the calculations is good both QA and a sound fiscal investment.