Coding for Treatment Devices
Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. Providers should bill for devices at the beginning of the treatment course and then may bill again later in the course of treatment when additional or new devices are required.
Payment for one set of treatment devices may be allowed per separate port when radiation therapy is started. However, a pair of mirror-imaged opposing ports, ports that direct parallel beams such as anterior-posterior or left lateral-right lateral pairs are considered, for billing purposes, to be one port. This is true regardless of the level of complexity of the devices used to create the ports. However, if these devices are significantly different from each other, then the contractor may allow payment for each of the pair Coding for Treatment Devices.
Choosing Correct CPT
It is the responsibility of the provider to determine the CPT code that most accurately describes the devices employed. At all levels of complexity, the physician must be directly involved in the design, selection, and placement of any of the devices. A pair of devices for opposing ports, constructed from drawings made by a physician on a single film, is considered for physician professional billing purposes to be one port.
Each individual device constructed may be billed separately by the facility. This is true regardless of the level of complexity of the devices used to create these ports. The physician must be directly involved in the design, selection, and placement of any of the devices. When the patient has a combination of a wedge compensator (complex beam modification device) and a bolus (simple beam modification device), covering the same treatment port, this would be billed as a single complex treatment device rather than as a separate charge for each of the additional items of lower complexity.
Level of Complexity for Treatment Devices
The level of complexity for treatment devices will be independent of each other. The number of different anatomic sites determines the number of sets or ports involved except opposing fields (such as AP/PA) which represent one set. Each set must be submitted on the claim, with the appropriate level of complexity at the onset of therapy or as appropriate when additional devices are implemented during a course of treatment.
You can use CPT code 77332 for simple treatment devices, design, and construction that include simple port blocks that include one or two hand-positioned pre-made blocks; simple prefabricated bolus that is capable of being shaped for an individual patient; or independent jaw motion or asymmetrical collimation.
You can use CPT code 77333 for intermediate treatment devices, design, and construction that include multiple port blocks which include three or more pre-made blocks such as corner pelvis blocks, beam splitter blocks, or midline spinal cord blocks; stents; bite blocks; or special multi-use bolus.
You can use CPT code 77334 for complex treatment devices, design, and construction that include customized, single-use bolus such as wax molds conformed to a particular patient body part; customized blocks (low-temperature alloy); customized compensators; wedges; molds or casts; custom made immobilization devices or eye-shields. Custom-made immobilization includes restraining devices such as aquaplast and alpha cradle. The use of passive restraints such as straps, pillows, sandbags, etc. is not billable.
We understand the challenges and issues in Oncology coding. Our expert and certified medical coding team will assign the right codes for each treatment. To know more about Radiation Oncology Billing and coding services, please get in touch with us!