Oncology & Hematology Coding Alert

Question: May I report IMRT code 77301 with 77295?


Washington Subscriber

Answer: Generally, you shouldn't report these two codes together. Code 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) includes the services described by 77295 (Therapeutic radiology simulation-aided field setting; three-dimensional), according to the American College of Radiology and most, if not all, payers.

Intensity modulated radiotherapy (IMRT) planning (77301) includes dose verification and positional accuracy plans, dose volume histograms for target and critical structure partial tolerances, and inverse plan optimization for highly conformal distributions.

Because the partial tolerance verification used to maximize the dose to the tumor while minimizing the dose to the surrounding tissues is included in 77301, you should not report it separately with 77331 (Special dosimetry [e.g., TLD, microdosimetry] [specify], only when prescribed by the treating physician) or 77370 (Special medical radiation physics consultation).

This service (77301) also includes generating required isodose curves, so you typically won't be reimbursed for teletherapy codes 77305-77321 if you report them with 77301.

Report 77301 once per course of treatment.

Caution: Don't report 77295 for IMRT plans that don't meet the medical necessity to be reimbursed as IMRT, the OIG's model compliance program warns. You also shouldn't use 77295 for an IMRT boost.

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president, AAPC National Advisory Board.