How To Use CPT Code 77295

CPT 77295 is a code for 3-dimensional radiotherapy planning, including dose-volume histograms. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77295 procedures.

1. What is CPT 77295?

CPT 77295 is a medical billing code used for 3-dimensional radiotherapy planning, which involves the use of computer-generated radiographic reconstruction and volumetric dose calculation to improve the accuracy of external beam radiation administration. This code is specifically used for procedures that involve the creation of a 3D radiotherapy plan, including dose-volume histograms, to ensure the most effective and safe treatment for patients undergoing radiation therapy.

2. 77295 CPT code description

The official description of CPT code 77295 is: “3-dimensional radiotherapy plan, including dose-volume histograms.”

3. Procedure

1. The provider uses fused data sets, such as imaging, to outline the patient’s target volumes.
2. The clinical target volume is determined by adding a small area around the visible tumor, called the gross tumor volume, to account for potential disease spread not yet visible on imaging.
3. Planning target volumes (PTVs) are added to account for planning and treatment delivery uncertainties, ensuring the radiotherapy is delivered to the clinical target volume (CTV).
4. Multiple PTVs may be required for a patient, depending on the tumor location and surrounding anatomy.
5. Based on tumor location, the provider identifies the organs at risk (ORs) and may add a margin around them to minimize radiation dose to an acceptable level.
6. The provider reviews the 3D computer dosimetry calculation provided by the physicist and dosimetrist, and they work together to adjust the plan to maximize treatment while minimizing damage to healthy tissue.
7. Creating the final plan may take several attempts.

4. Qualifying circumstances

Patients eligible to receive CPT code 77295 services are those who require external beam radiation therapy for the treatment of cancerous tumors. The 3-dimensional radiotherapy planning is necessary to ensure accurate and effective delivery of radiation to the tumor while minimizing damage to surrounding healthy tissue and organs at risk. This code is applicable for patients with various types of cancer and tumor locations, as long as the treatment plan involves the use of 3D radiotherapy planning and dose-volume histograms.

5. When to use CPT code 77295

It is appropriate to bill the 77295 CPT code when a patient requires external beam radiation therapy and the treatment plan involves the use of 3-dimensional radiotherapy planning, including dose-volume histograms. This code should be used for procedures that involve the creation of a 3D radiotherapy plan to ensure the most effective and safe treatment for patients undergoing radiation therapy.

6. Documentation requirements

Documentation supporting a claim for CPT 77295 should include the following information:

• Patient’s medical history and diagnosis, including the type and location of the tumor.
• Details of the 3D radiotherapy planning process, including the use of fused data sets, target volume determination, and planning target volumes.
• Identification of organs at risk and any margins added to minimize radiation dose.
• Summary of the 3D computer dosimetry calculation, including dose distribution and dose volume histograms.
• Details of the final treatment plan, including any adjustments made to maximize treatment effectiveness and minimize damage to healthy tissue.
• Signature of the provider, physicist, and dosimetrist involved in the planning process.

7. Billing guidelines

When billing for CPT code 77295, it is important to follow the appropriate billing guidelines and rules. Ensure that the documentation supports the use of this code, including the necessary details of the 3D radiotherapy planning process and the involvement of the provider, physicist, and dosimetrist. Additionally, be aware of any payer-specific requirements or guidelines that may apply to the billing of CPT code 77295.

8. Historical information

CPT 77295 was added to the Current Procedural Terminology system on January 1, 1994. There have been changes to the descriptor of this code over the years:

• Code Changed on 01-01-2014: Therapeutic radiology simulation-aided field setting; 3-dimensional
• Code Changed on 01-01-2006: Therapeutic radiology simulation-aided field setting; three-dimensional

9. Similar codes to CPT 77295

There are several codes similar to CPT 77295, which differ in the specific aspects of radiotherapy planning they cover:

• CPT 77261: Involves simple radiotherapy treatment planning.
• CPT 77262: Involves intermediate radiotherapy treatment planning.
• CPT 77263: Involves complex radiotherapy treatment planning.
• CPT 77280: Involves simple simulation-aided field setting.
• CPT 77285: Involves intermediate simulation-aided field setting.

10. Examples

Here are 10 detailed examples of CPT code 77295 procedures:

1. A patient with lung cancer requires external beam radiation therapy, and the treatment plan involves the use of 3D radiotherapy planning to accurately target the tumor while minimizing damage to surrounding healthy tissue.
2. A patient with prostate cancer undergoes 3-dimensional radiotherapy planning to ensure precise delivery of radiation to the tumor and minimize damage to nearby organs at risk.
3. A patient with breast cancer requires external beam radiation therapy, and the treatment plan involves the use of 3D radiotherapy planning to accurately target the tumor while minimizing damage to surrounding healthy tissue and organs at risk.
4. A patient with brain cancer undergoes 3-dimensional radiotherapy planning to ensure precise delivery of radiation to the tumor and minimize damage to nearby healthy tissue.
5. A patient with head and neck cancer requires external beam radiation therapy, and the treatment plan involves the use of 3D radiotherapy planning to accurately target the tumor while minimizing damage to surrounding healthy tissue and organs at risk.
6. A patient with cervical cancer undergoes 3-dimensional radiotherapy planning to ensure precise delivery of radiation to the tumor and minimize damage to nearby organs at risk.
7. A patient with esophageal cancer requires external beam radiation therapy, and the treatment plan involves the use of 3D radiotherapy planning to accurately target the tumor while minimizing damage to surrounding healthy tissue and organs at risk.
8. A patient with pancreatic cancer undergoes 3-dimensional radiotherapy planning to ensure precise delivery of radiation to the tumor and minimize damage to nearby healthy tissue and organs at risk.
9. A patient with liver cancer requires external beam radiation therapy, and the treatment plan involves the use of 3D radiotherapy planning to accurately target the tumor while minimizing damage to surrounding healthy tissue and organs at risk.
10. A patient with bone cancer undergoes 3-dimensional radiotherapy planning to ensure precise delivery of radiation to the tumor and minimize damage to nearby healthy tissue and organs at risk.