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The brachytherapy isodose plan, as defined by CPT® Code 77318, is a specialized procedure that involves the creation of a detailed radiation treatment plan tailored to the individual needs of a patient. This procedure is typically carried out by a medical dosimetrist and/or a qualified medical physicist, all under the supervision of a radiation oncologist. Brachytherapy itself is a form of internal radiation therapy that delivers localized and precise doses of radiation directly to a tumor or affected area by implanting radioactive seeds or pellets. These implants can be temporary or permanent, depending on the treatment requirements. The isodose plan is critical as it determines the specific technique to be used, the exact dosage of radiation to be administered, and the type of radioactive material employed, which may include isotopes such as iodine, palladium, cesium, or iridium. The isodose plan also plays a vital role in assessing the radiation tolerance of surrounding healthy tissues, ensuring that the treatment is both effective against the tumor and safe for the patient. In temporary brachytherapy, the radioactive source is placed within a catheter or tube for a predetermined duration, after which it is removed. This technique can utilize various dosing rates, including low-dose rate (LDR), pulse-dose rate (PDR), or high-dose rate (HDR), each with distinct treatment schedules. Conversely, permanent brachytherapy involves the implantation of seeds that gradually release their radioactive material over several months until it is fully depleted. The complexity of the brachytherapy isodose plan is reflected in the number of sources used for calculations; CPT® Code 77318 specifically applies when calculations are derived from more than 10 sources or when remote afterloading involves more than 12 channels, indicating a higher level of intricacy in the planning process compared to simpler codes.
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The brachytherapy isodose plan (CPT® Code 77318) is indicated for patients requiring precise and localized radiation treatment for various medical conditions, particularly tumors. The following conditions may warrant the use of this complex planning procedure:
The procedure for creating a complex brachytherapy isodose plan involves several critical steps, each essential for ensuring accurate and effective treatment delivery. The following outlines the procedural steps:
After the brachytherapy procedure is completed, patients typically undergo a period of monitoring to assess the immediate effects of the treatment. Post-procedure care may include managing any side effects, such as localized discomfort or radiation-related symptoms. Patients are often advised on follow-up appointments for imaging and evaluation of treatment efficacy. Additionally, instructions regarding safety precautions, especially for those receiving temporary brachytherapy, are provided to minimize radiation exposure to others. The recovery process varies depending on the individual and the specific brachytherapy technique used, with ongoing assessments to monitor the patient's response to treatment and any potential complications.
| Short Descr | BRACHYTX ISODOSE COMPLEX | Medium Descr | BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL | Long Descr | Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | Type of Service (TOS) | 6 - Therapeutic Radiology | Berenson-Eggers TOS (BETOS) | P7A - Oncology - radiation therapy | MUE | 1 |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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