This August, the American Medical Association (AMA) introduced the 2015 CPT code changes that will go into effect on January 1, 2015 with significant changes for radiation oncology. The revised brachytherapy and teletherapy isodose planning codes are among them. As the standards of care in this field are changing, conventional isodose planning is used less frequently and the corresponding CPT codes are overlooked. These codes are applicable to cases in which the criteria for 3D, IMRT or stereotactic (latest trends) are not met and commonly used for metastatic treatments to the brain and bone or areas in which a volume of interest and a critical structure are not defined and used for planning purposes. It is very important to understand the new changes to avoid claim denials.
Teletherapy Isodose Planning
The three codes used for teletherapy isodose planning 77305, 77310, 77315 have been deleted. Instead, two new codes will be used to report this service:
- 77306: Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
- 77307: Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
Brachytherapy Isodose Planning
The three brachytherapy CPT codes 77326, 77327 and 77328 have been deleted. New three codes have been introduced to report this service.
- 77316: Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
- 77317: Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)
- 77318: Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)
All the five new codes include the work associated with the basic dosimetry calculation. The code 77300 should not be reported with these codes. For Medicare values for the new CPT codes, check the 2015 Medicare Physician Fee Schedule Final Rule.
It is time for radiation oncology practices to review their documentation and billing and make appropriate modifications to accommodate these changes. Comprehensive training should be provided to office staff to address these changes and ensure that the codes are reported correctly. Considering the support of professional billing and coding services is advisable from the point of view of reducing workload and improving productivity and revenue.