Activity 4: CPT Codes

Activity
Examine one radiation oncology record for a patient who has completed radiation treatments.
Provide a brief introduction of the patient case (e.g., age, type of cancer, etc). Discuss the patient
medical insurance information and how treatments were paid for. Provide a detailed list of all
CPT codes charged to the patient account. How accurate is this? What was or why was each item
billed?
What is the status of reimbursement on the account? What do you think about this billing, coding
and reimbursement for this account? Anything alarming? Confusing? Cause for concern?
Response
Patient JZ is a 57 year old perimenopausal female recently diagnosed with cT4aN1 IDC of the
left breast grade 2 and ER positive. She was scanned in supine position immobilized with a
breast board. Tattoos were placed on her skin to assist with daily setup on the treatment
machine. The insurance was provided by Medicaid. The ICD 9 code used was 174.4 for upperouter quadrant of tAhe breast.
The patient was treated with a 3-field 3D CRT plan with a total of 8 control points on the tangent
beams. The tangent beams consisted of 4 mixed energy beams (two 6 MV and two 18 MV).
The prescription was 50.4 Gy in 1.8 Gy daily fractions.
The CPT codes charged to the patient account are given in the attached table.
The charges seem to correspond accurately to the services that were rendered to the patient. For
instance the charges that were done in dosimetry i.e. Codes 77300 for 5 beams, 77295 for one 3D
Plan, 77263 x1 for new patient, T77334 for one tangent beam that was opposed to the original,
and 77334 (global charge) x 10, for the 8 control points plus two original beams that were
created by the radiation oncologist. This is our standard way of charging for breast treatments.
The only thing I would like to point out here is that we charge every control point created.

Activity 4 Case Study CPT Codes Table

No

CPT Code

Description

Frequency

77427

Rad Tx Mgmt, Tx

77414

Complex 18MV

19

77336

Continuous Phys

77417

Portfilm

77280

Simulation Simple

77300

Dosimetry manual calc.

77295

Simulation 3D Plan

77334

Tx Device (Global)

10

77334

Tx Device (Technical)

10

77263

Clinical Tx Plan

11

77290

ACQ/Sim Complex

12

77333

Tx Device