Article - Billing and Coding Guidelines for Intensity Modulated Radiation Therapy (IMRT)

A recent Office of Inspector General (OIG) review found $25.8 million in hospital overpayments for intensity-modulated radiation therapy (IMRT) planning, which suggests a need for greater education around reporting of these services. This article will provide insight into basic billing guidelines for (IMRT).

Medical Radiation Physics, Dosimetry and Treatment Devices for use with IMRT

  • Basic Radiation: Dosimetry Basic radiation dosimetry is a separate and distinct service from IMRT planning and should be reported accordingly. The radiation dose delivered by each IMRT beam must be individually calculated and verified before the course of radiation treatment begins. Thus, multiple basic dosimetry calculations (up to 10) are typically performed and reported on in a single day. Supporting documentation should accompany a claim for more than ten (10) calculations in a single day.
  • IMRT Dosimetry: CPT code 77300 basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NDS, gap calculation, off-axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface, and depth dose, as required during the course of treatment, only when prescribed by the treating physician.
  • CPT code 7730: Intensity-modulated radiation therapy (IMRT) plan, including dose-volume histograms for target and critical structure partial tolerance specifications. (Dose plan is optimized using inverse or forward planning technique for modulated beam delivery (e.g., binary dynamic MLC) to create highly conformal dose distribution. Computer plan distribution must be verified for positional accuracy based on dosimetry verification of the intensity map with verification of treatment set-up and interpretation of verification methodology) This code is typically reported only once per course of IMRT.

IMRT Treatment Delivery

  • Collimator-based IMRT Treatment Delivery: CPT/HCPCS code G6015 Intensity Modulated Radiation Therapy (IMRT) delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session.
  • Compensator-based IMRT Treatment Delivery: CPT/HCPCS code G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using three or more high resolution (milled or cast) compensator convergent beam modulated fields, per treatment session.

Treatment Devices

There are several categories of treatment devices used in conjunction with the delivery of IMRT radiotherapy. It is appropriate to report a treatment device CPT code for each complex IMRT field (i.e., gantry/table angle for step and shoot and sliding windows). It should not be billed for each segment within the field. CPT code 77334 is typically billed multiple times (often on the same day of service), once for each of the separate IMRT fields as required by the plan during the course of IMRT treatment. The typical case will require up to ten (10) devices. A claim for the use of more than ten (10) should be submitted with supporting documentation.

CPT codes for IMRT Treatment Devices

  • 77332 treatment devices, design, and construction; simple (simple block, simple bolus) 
  • 77333 treatment devices, design, and construction; intermediate (multiple blocks, stents, bite blocks, special bolus) 
  • 77334 treatment devices, design, and construction; complex (irregular blocks, special shields, compensators, sedges, molds or casts)

Devices

  • CPT code 77338 Multi-Leaf Collimator (MLC) device(s) for Intensity Modulated Radiation Therapy (IMRT), design, and construction per IMRT plan. Do not report 77338 more than once per IMRT plan. Do not report 77338 in conjunction with G6016, compensator based IMRT. 
     
  • G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator convergent beam modulated fields, per treatment session. For treatment planning, use 77301. Do not report G6016 in conjunction with 77401, G6003-G6014, or G6015.

Image-Guided Radiation Therapy (IGRT)

Image-Guided Radiation Therapy (IGRT) utilizes imaging technology to modify treatment delivery to account for changes in the position of the intended target. IGRT is used in conjunction with IMRT in patients whose tumors are located near or within critical structures and/or in tissue with inherent setup variation. Although an IGRT is a distinct service, it may be used and documented along with IMRT treatment delivery (G6015) when necessary.

CPT codes for IGRT:

  • G6001: Ultrasonic guidance for placement of radiation therapy fields
  • 77014: Computed tomography guidance for placement of radiation therapy fields
  • G6002: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
  • G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy(e.g.,3-D positional tracking, gating, 3-D surface tracking), each fraction of treatment

The following CPT codes were used as building blocks during the development of the IMRT planning CPT code. They are components of CPT code 77301 and therefore should not be separately coded or billed on the same day of service:

  • 76370 / 77014 (deleted/current): Computerized axial tomography guidance for placement of radiation therapy fields
  • 76375/ 76376 (deleted/current): Coronal, sagittal, multiplanar, oblique, three-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomography modality
  • 77295: Therapeutic radiology simulation-aided field setting; Three-dimensional simulation
  • 77331: Special radiation dosimetry

The following list of codes should not be reported on the same date of service as IMRT planning (77301). They may, however, correctly be used, as needed, for medically necessary simulation and treatment planning during the course of IMRT treatment (i.e. with code G6015):

  • 77280:  Therapeutic radiology simulation-aided field setting, simple
  • 77285: Therapeutic radiology simulation-aided field setting, intermediate
  • 77290: Therapeutic radiology simulation-aided field setting, complex

IMRT is a valuable tool in the treatment of certain cancers. Be sure to maintain appropriate and compliant documentation to support the processes that go into this type of therapy. Knowing the guidelines for billing and coding IMRT is critical to proper payment. In case of any assistance for oncology medical billing and coding, you can contact us at 888-357-3226info@medicalbillersandcoders.com


Published By - Medical Billers and Coders
Published Date - Mar-04-2020 Back

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