Oncology & Hematology Coding Alert

Question: Can we bill more than one special medical physics consult (77370) during a patients course of treatment?

Kentucky Subscriber  
Answer: Generally, 77370 (special medical radiation physics consultation) is billed once per course of therapy for the additional work performed by the physics staff. There are rare exceptions to this general practice, such as when two different modalities -- external beam followed by brachytherapy -- are used to treat a patient.
 
Code 77370 should be used for consultations when a unique problem or special situation arises during radiation therapy. It requires that the requesting physician receive a detailed written report describing the problem.
 
The physician, with a small explanation outlining why the request is made, must request the special physics consult in writing. Then the physicist will respond back to the physician with a technical narrative about the patient, explaining the information in physics terms. The physicist and the physician should sign this document.
 
It is important to note that 77370 is considered a technical service-only code. It carries no physician component and is billed exclusively by the institution delivering the treatment. It is payable by Medicare Part B only in settings where the physicians office contains the equipment and staff to complete the consultation, such as a freestanding radiation oncology center that employs its own radiation physicist.
 
For example, 77370 would commonly be used when the radiation oncologist notices an abnormality during his or her weekly review of port films. The radiation oncologist would request the consultation of a physicist. If the physicist provides services that fall outside the routine assessment of treatment parameters, quality assurance of dose delivery and review of patient treatment documentation, then 77370 is appropriate. Also, if the patient is undergoing total-body irradiation, sterotactic radiosurgery, 77370 can also be billed by the facility that employs the physicist.  
-- Answers to Reader Questions and You Be the Coder were provided by Margaret Hickey, OCN, CORLN, an independent coding consultant in New Orleans; Cindy Parman, CPC, CPC-H, president and co-founder of Coding Strategies Inc. in Dallas, Ga.; Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett, N.H.; and Dianna Hoffbeck, president of Northshore Medical in Atlantic City, N.J.