Radiology Coding Alert

Question: Our physician documented "CT radiation therapy planning." How can we report this service, considering that 76370 does not include a professional component and we did not perform the technical portion?

Kentucky Subscriber

Answer: Code 76370 (Computed tomography guidance for placement of radiation therapy fields) does include a separate professional component, but you should report it only if the radiologist performs a medically necessary, complete interpretation of the computed tomography (CT) scan.

If your radiation oncology department owns a dedicated CT unit, the radiation oncologist uses the data for treatment planning only and does not perform a full diagnostic reading. You should therefore report only the technical portion of the code (76370-TC, Technical component). Occasionally, the radiation oncologist will ask the radiologist to interpret the scan and provide a full diagnostic report. In this instance, the radiologist can report 76370-26 (Professional component).

If the radiation oncologist uses the CT data for virtual simulation and/or planning, he should document a dedicated simulation or planning note. Because 77295 (Therapeutic radiology simulation-aided field setting; three-dimensional) includes 76370's professional component, a radiation oncologist should not separately report 76370-26 in this situation. The manual contouring of the critical and sensitive structures is considered part of the 3D planning process. 

And, many payers will not reimburse 76370-26 because they believe that the physician already knows the patient's condition and the location and extent of the cancer, making the physician's role in this CT scan medically unnecessary.