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Radiation Theary
Radiation Theary
The radiation oncology process of care can be separated into the following six categories:
Consultation
Consultation
What is it? A consultation is a type of evaluation and management service provided by a physician at
the request of another physician or appropriate source. The outcome of the consultation will be to
either recommend care for a specific condition or problem, or determine whether to accept
responsibility for ongoing management of the patient’s entire care or for the care of a specific
condition or problem.
Tasks performed. The clinical team, led by the radiation oncologist, provides the medical services
associated with the process of care. The physician, as part of this process, will review the pertinent
radiographs, pathology reports, patient complaints and physical findings.
CPT codes. The consultation E/M services are reported using the 99xxx series in the CPT® codes. Note
that as of January 1, 2010, CMS has eliminated payment for office and inpatient consultation codes
and providers are directed to report other appropriate E/M CPT codes.
This phase in the process of care includes clinical treatment planning and simulation services.
CPT codes. Clinical treatment planning services are reported using CPT codes 77261-77263.
Simulation
What is it? Simulation is the process of defining relevant normal and abnormal target anatomy, and
acquiring the images and data necessary to develop the optimal radiation treatment process.
Tasks performed. Utilizing simulation equipment, the exact treatment position for the patient is
defined. This may include marking the area to be treated on the patient’s skin, aligning the patient
with localization lasers, and/or designing immobilization devices to ensure precise patient
positioning. Each port or field is visualized in reference to the proper landmarks. Documentation of
the size, angle, distance and other working parameters are recorded during simulation. Simulation
may be performed more than once during a course of treatment — e.g., in some brachytherapy
circumstances, it can be twice per day.
CPT codes. Simulation services are reported using CPT codes 77280-77290.
Respiratory motion management simulation
What is it? In current clinical practice, simulation is performed with motion management to inform
field and portal design with precise knowledge about the respiratory movement of target tissue and
organs at risk.
Tasks performed. This new code describes the physician work involved in simulating a patient using
motion (respiratory) tracking of a mobile target volume. The work involves acquisition and review of
multiple additional CT images that allow for a full accounting of breathing-related tumor motion.
CPT codes. Respiratory management simulation is reported using CPT code +77293.
Medical radiation physics, dosimetry, planning, treatment devices and special services
What is it? During this phase, a mathematical computation of the specific radiation dose at a
particular point is developed. The radiation oncology team develops the appropriate dosimetry
calculations and isodose plan, builds treatment devices to refine treatment delivery, and performs
any other special services required for the precision of dose delivery.
Tasks performed. The physician, with the assistance of a qualified medical physicist, prescribes,
supervises, designs, reviews and clinically confirms all aspects of each activity in this phase of care.
CPT codes. Medical radiation physics, planning, dosimetry, treatment devices, and special services
are reported using: 77295, 77300, 77331, 77301, 77338, 77306-77307, 77316-77318, 77321, 77332-
77334, 77336 and 77370.
What is it? Radiation treatment is delivered using either a type of external beam radiation or
brachytherapy, and includes various methods, modalities and complexities. Delivery codes are
normally used each day of treatment, in some instances twice a day. Energy level and complexity of
treatment determine the appropriate treatment delivery CPT code to report.
Tasks performed. The physician is responsible for verification and documentation of the accuracy of
treatment delivery as related to the initial treatment planning and setup procedure.
CPT codes. Treatment delivery is reported using the following CPT codes:
CPT codes. Image-guided radiation therapy (IGRT) is reported using the following CPT codes:
Image-guided radiation therapy (IGRT): 77387, G6001, G6002, G6017 and 77014
Note that brachytherapy may have a different process of care that is not fully addressed within this
document.
What is it? Radiation treatment management represents the radiation oncologist’s professional
contribution to patient management during the course of treatment.
Tasks performed. For the radiation oncologist, radiation treatment management requires and
includes a minimum of one examination of the patient by the physician for medical evaluation and
management. The professional services performed during the treatment management phase
typically include: review of port films; review and changes to dosimetry, dose delivery and treatment
parameters; review of the patient’s setup; and patient examination.
Not all of these parameters of treatment management are completed each week (except for the
patient examination) because the clinical course of care may differ due to variation in treatment
modality and individual patient requirements.
CPT codes. Radiation treatment management is reported using the following CPT codes: 77427,
77431, 77432, 77435, 77469 and 77470.
Follow-up care is the last phase in the process of care for a radiation therapy patient. Continued care
is appropriately provided by the radiation oncologist to monitor the patient for tumor recurrences.
Medicare will not pay for routine follow-up care during the three months after completion of
external beam therapy, since this is considered part of the treatment management.