| Question:
Billing / Is RadCalc considered to be a dose verification method that can be used to document 77300 for IMRT? Updated for 2009
Answer:
The following information is provided by Churchill Consulting, Inc.
REPORTING 77300 with IMRT
In 2003, the Centers for Medicare and Medicaid Services deleted the correct coding initiative edit that bundled IMRT planning CPT® code 77301 with the dosimetry calculation CPT® code 77300. Basic dosimetry calculations that are performed as a separate and distinct process from the IMRT plan are reportable events.
Sample LCD for IMRT Basic Dosimetry 77300
Use of Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician CPT 77300 in IMRT .
The IMRT plan CPT 77301 produces monitor units MUs for each gantry angle. A separate claim for basic dosimetry 77300 is appropriate only when there is a separate and distinct service, prescribed by the treating physician, over and above those that are a part of the IMRT plan. 77300 is appropriate to describe a necessary, independent calculations performed outside the parameters of, and on a different date of service than the IMRT plan 77301. It is not appropriate to automatically report this service for the computerized IMRT plan, or for the films, phantoms or equivalent done as a part of the 77301 or as may be a part of a separately performed and billed 77370.
DOCUMENTING 77300 for IMRT
In order to qualify 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 often encounter situations where the organization automatically reported a basic dosimetry for each monitor unit that the IMRT computer plan generated, but they do not have any corresponding calculations available to support the service 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. Churchill is very 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. Note that a package signature physician approval of all planning on the cover page of a plan is not adequate. Be sure that the physician orders the basic dosimetry calculations and signs and dates those 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 |
$114.70 |
$688.20 |
| Technical Medicare |
$40.39 |
$242.34 |
| Professional Medicare |
$31.02 |
$186.12 |
| Global Medicare |
$71.41 |
$428.46 |
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 both good for QA and a sound fiscal investment.
For more information, please contact:
Deborah I. Churchill, President
Churchill Consulting, Inc.
Phone:8606635630
Fax:8606635633
Email:ChrchlCCI@aol.com
Website: www.ChurchillConsulting
An expert in oncology billing, Deborah regularly conducts CPT Billing Seminars for Radiation Oncology. In addition to private seminars Deborah has also conducted seminars for the New England Society for Radiation Oncology, AAMD, AAPM, SROA and OROS. Deborah has conducted focused seminars for organizations that include IMPAC Medical Systems, ELECTA, MDS Nordion, Medical Technology Management Institute and Radionics. Deborah has published articles in Advance Magazine, Oncology Nursing Society and is a contributing editor for The Coding Institute.
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