# Radiation Oncology Help Please!!



## washington-hunt (Dec 8, 2014)

Can anyone explain the difference between CPT code 77334 and 77338. My understanding is CPT code 77338 is for IMRT device billed with CPT code 77301 (IMRT planning)and includes CPT code 77334 unless there is a modification to a device than CPT code 77334 can be added with modifier 59. 

CPT code 77334 is billed with CPT code 77300 (basic radiation dosimetry calculation.

I've read the LCD as well as ASTRO guidelines and I'm still not clear.


 Confused:


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## teblizzy (Dec 9, 2014)

CPT code 77334 is for immobilization devices (masks, vac loks etc.) created at the time of simulation and for treatment devices created at the time of treatment planning.  It is a complex level device and can only be billed with 77301 for compensator based IMRT devices.  These are devices which are milled and purchased from an outside company and manually loaded into the treatment machine.  When supported you can bill one per port of entry, typically one per gantry angle.  The corresponding treatment code in 2014 is 0073T.  For 2015 it will be 77385 (hospital) or G6016 (FSC).

CPT code 77338 is billable with 77301 for MLC (multi-leaf collimator) based IMRT.  This is more common than the compensator based planning and treatment.  Regardless of the number of gantry angles only one 77338 is billable per IMRT plan.  The corresponding treatment code is 77418 in 2014 or 77385 or 77386 (hospital) or G6015 (FSC) in 2015.  The documentation for either will be a fluence map and if you can talk to the dosimetrist about the plan generated, they should be able to show you the difference.  The compensator for the IMRT will have additional documentation from the manufacturer.  

Typically the number of 77334 will match the 77300, but this is not always the case.  For IMRT the secondary calculations are the supporting documentation.  Code 77334 is also billed with isodose planning codes 77315 in 2014 or 77307 in 2015.  It can also be billed with 77295.  Again one per port of entry and this billing for the device created on the computer that shapes the radiation beam as it travels out of the machine and treats the patient.

It can be confusing.  For the IMRT a center is usually one or the other.  Your machine will either be MLC based or compensator based.  Then the planning will match based on what the machine can do.

Hope that helps.


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## washington-hunt (Dec 9, 2014)

*Radiation Oncology Help*

In the 1st paragraph you're saying CPT code 77334 is a complex device  and can only be billed with CPT code 77301. Is this correct? Because they 3rd paragraph you said 77334 is typically billed with 77300.

Also, I'm coding for the physician, would I use 0073T or 77418 for treatment?


Thank you for your help


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## teblizzy (Dec 9, 2014)

In the first paragraph I said 77334 can only be billed with 77301 for compensator based IMRT.  Only if the plan and treatment are compensator based IMRT will you bill 77334 with 77301, this is not as common as most treatment machines have MLC in them and do not need the compensators which are billed as 77334.  Most IMRT is MLC based which will be 77338 and 77301.  I recommend you ask dosimetry what kind of MLC is planned or treated, MLC or compensator based.

Code 77334 is used in many scenarios.  It can be billed with the simulation or treatment planning.  The treatment planning codes available for 2015 include 77306, 77307, 77321, 77295 or 77301.  In addition to the treatment plan code will be 77300 for the MU calculations (not billable with 77306, 77307 or 7731 in 2015) and 77332, 77334 or 77338 for treatment devices.  It depends on they type of plan generated.  

Treatment codes 0073T and 77418 are technical only they are not billed for the physician, but if you look to see what was captured by or scheduled by the technical side for the patient this will also tell you if the correct combo is 77334 and 77301 or 77338 and 77301.


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## zaidaaquino (Mar 26, 2015)

*77338 and g6015*

Hello.  I was question regarding 77338 and G6015.  Per NCCI edits, there is an edit when these two codes are billed together, correct?  I have one radiology person telling me no modifier is required?? Please advise...thanks.


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## teblizzy (Mar 26, 2015)

Per the CCI edits, a modifier is needed on 77338 when billed on same date as G6015.  A -59 modifier would be the best modifier to use.


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