Physics
Coding Question: A previously treated patient has imaging studies performed after the conclusion of radiation therapy. The radiation oncologist requests a special medical physics consultation to fuse the simulation CT and radiation dose to the follow-up imaging study to evaluate tumor response and/or organs-at-risk (OAR) damage with respect to the dose delivered. Can a 77370 be billed even though the patient is not undergoing a course of treatment?
Coding Answer: CPT® code 77370 (Special medical radiation physics consultation) is used when the radiation oncologist makes a direct request to the qualified medical physicist for a special consultative report or for specific physics services for an individual patient. This service is generally associated with a specific course of treatment. However, situations may arise where an analysis and written report is necessary to address a specific problem and when the service to be performed requires the expertise of a qualified medical physicist to provide information regarding past treatments to inform the physician’s decision-making process. An example might be the analysis of the effects of previous radiation therapy with assessment of cumulative radiation dose to critical organs requiring fusion of previous planning CTs, dose distributions, OARs, treatment volumes, follow-up imaging studies, etc. CPT code 77370 should not be reported if this work is used to guide future IMRT treatment planning to the area or for outcomes analysis or quality improvement purposes only.
Coding Question: What does the physician's request for a special physics consultation (77370) need to entail? Can it be a box that is checked off and initialed by the MD?
Coding Answer: A special physics consultation (CPT® code 77370) requires a written request that is signed and dated by a physician. A simple check-off box in the patient chart is not sufficient and a description of the purpose of the consult is necessary. However, a descriptive special physics consultation order for common uses may be developed. Regardless, the request must be specific to a particular patient and must address the particular problem and/or service that requires the expertise of a qualified medical physicist.
Coding Question: What does the physicist’s report for special physics consultation (77370) need to include? Can it be a box that is checked off and initialed by the physicist?
Coding Answer: A special physics consultation (CPT® code 77370) requires a report that is signed/dated by a qualified medical physicist and approved/dated physician. A simple check-off box in the patient chart is not sufficient and a description of the results of the consult is necessary. A descriptive special physics consultation summary for common uses may be developed to facilitate this task but should be accompanied by a customized special physics consultation report that is appended to the patient’s chart.
Coding Question: What are the supervision requirements for physicists and dosimetrists for weekly chart checks? Can this be done from a remote location?
Coding Answer: Weekly chart checks should be performed by a qualified medical physicists (QMP) per ASTRO and ACR-AAPM standards of practice. Non-QMP personnel such as dosimetrists should participate only under direct supervision of a QMP. Weekly physics chart checks can be performed remotely. Many other physics tasks that are part of the Continuing Physics Consultation (CPT code 77336) must be performed on site.
Coding Question: What is the supervision requirement for physicists during SBRT delivery?
Coding Answer: A physicist must be available onsite during patient imaging and treatment to provide personal supervision.
References:
2023 ASTRO Radiation Oncology Coding Resource
ASTRO's 2020 Supervision Guidance
ACR-AAPM's Practice Parameters and Technical Standards
Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2022, American Medical Association. All Rights Reserved.
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