June 30, 2014

ACR Radiology Coding Source™ May-June 2014 Q and A

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Q: A payer is requiring preauthorization for radiation therapy treatments. Many of us are having a hard time getting IMRT (77301) authorized for left breast cancer. The payer is trying to redefine 77301 and has the following statement on the request form: Are you delivering adjuvant therapy to the whole breast or chest wall using two gantry angles and 3D conformal treatment planning, and with(or without) an electron or photon boost? How is forward-planned Intensity Modulated Radiation Therapy (IMRT) reported? The CPT® 2014 codebook does not mention how this should be reported.

A: The field-in-field techniques that are now often called Intensity Modulated Radiation Therapy (IMRT) did not exist when IMRT and three-dimensional (3D) conformal procedures were initially described. The delivery codes for 2015 will make it explicitly clear that field-in-field techniques, which are often misnamed forward-planned IMRT, are to be reported as 3D conformal with code 77295 3-dimensional radiotherapy plan, including dose-volume histograms).