Oncology & Hematology Coding Alert

Question: Can more than one special medical physics consult, 77370 (special medical radiation physics consultation) be performed during a patient's course of treatment?

Oregon Subscriber

Answer: Generally 77370 is billed once per course of therapy for the additional work performed by the physics staff. Exceptions are rare, such as when two different modalities external beam followed by brachytherapy are involved in the treatment of a patient. Then the code could be billed with each.

Code 77370 should also be used for consultative purposes when a unique problem or special situation arises during radiation therapy. It requires a detailed written report describing the problem to be given to the requesting physician.

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. 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 physician's 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 in cases when the radiation oncologist notices an abnormality during his or her weekly review of port films. The specialist would request the consultation of a physicist. If this person 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 or sterotactic radiosurgery, 77370 can be billed by the facility that employs the physicist.