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Learning Objectives:
77336: Maintaining the strength of
the Continuing Medical Physics
Consultation CPT ®code.
• Understand the components of the work effort
associated with the Continuing Medical Physics
Consultation CPT© code (77336)
• Understand how the code is valued and priced by
Medicare
• Offer opinions and comments on strategies to properly
value the CPT© code 77336
• Implement procedures in the clinic that properly reflect
the description of the code provided by AAPM and
ASTRO
Gerald A. White, Jr., M.S.
Colorado Associates in Medical Physics
Member, AAPM Professional Economics Committee
Roadmap to Reimbursement Related
Acronyms Essential to Medical
Physicist Solvency (RÆMPS)
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CMS: Center for Medicare and Medicaid Services. The federal agency
responsible for policy regarding Medicare and Medicaid
Medicare Part A: The CMS basket that pays for inpatient services.
Medicare Part B: The CMS basket that pays for Physician fees, technical
costs in an outpatient setting, including hospital based outpatient Tx.
Fiscal Intermediary: CMS contractor who manages Medicare Part A
payments for a fixed (usually multi-state) area.
Medical Carrier: CMS contractor who manages Medicare Part B payments
for a fixed (usually multi-state) area.
DRG: Diagnostic Related Groups. Classification system for hospital inpatients
in which a single payment from CMS is made of all services associated with
an admission.
HOPPS: Hospital Outpatient Prospective Payment System. Classification
system for hospital based outpatient Tx in which CPT © Codes are grouped
into “similar” sets, each set is paid at a fixed rate
CPT® Code: Classification system produced by the AMA in which medical
procedures are described and assigned a 5 digit code for billing purposes.
Roadmap to Reimbursement Related
Acronyms Essential to Medical
Physicist Solvency (RÆMPS)
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APC: Ambulatory Payment Classification. The payment sets used for the
HOPPS system. Modified annually.
MFS: Medicare Physician Fee Schedule. List of CPT © codes and associated
CMS payment rates. Modified annually.
PC: Professional Component. The portion of the MFS CPT © code payment
associated with the physician work effort
TC: Technical Component: The portion of the MFS CPT © payment
associated with the non-physician expense of delivering the service
RVU: Relative Value Unit. Arbitrary unit used to rank the work effort
associated with the PC of medical procedures.
RUC: Relative Value Update Committee. Maintained by the AMA, evaluates
the work effort and expense associated with the PC of CPT © codes and
recommends values to CMS.
PEAC: Practice Expense Advisory Committee. Maintained by the AMA,
evaluates the work effort and expense associated with the TC of CPT © codes
and recommends values to CMS.
HCPCS: Health Care Common Procedure Coding System. A system
analogous to the CPT© coding system, but maintained and valued by CMS.
SGR: Sustainable Growth Rate. Congressionally mandated system that
constrains the overall growth of certain Medicare expenditures
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77336 : Continuing Medical Physics
Consultation
77336 : Continuing Medical Physics
Consultation
• CPT® 77336 Continuing medical physics
consultation, including assessment of
treatment parameters, quality assurance
of dose delivery, and review of patient
treatment documentation in support of the
radiation oncologist, reported per week of
therapy.
• The continuing medical radiation physics
consultation (CPT® code 77336) is used to
describe the ongoing medical physics
assessment provided by a qualified
medical physicist to each patient receiving
radiation therapy.
77336 : Continuing Medical Physics
Consultation
77336 : Continuing Medical Physics
Consultation
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weekly chart reviews
review and analysis of medical physics aspects of
changes to the treatment regime
consultation on patient setup and treatment
modifications
verification of dose calculation data
reviewing accuracy of the current data record
review of patient-specific therapist treatment and
technical notes,
patient radiation safety.
ASTRO/ACR Guide to Radiation Oncology Coding
ASTRO/ACR Guide to Radiation Oncology Coding
The medical physicist will review all aspects
of the treatment delivery, including correlating the
treatment prescription with the technical and medical
physics aspects of the treatment, and with the actual
execution of the treatment.
Appropriate modifications to the technical aspects of the
patient treatment are formulated and the medical physicist
will recommend implementation of these modifications, as
required, in a timely fashion.
ASTRO/ACR Guide to Radiation Oncology Coding
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77336 : Continuing Medical Physics
Consultation
The medical physicist will review all aspects
of the treatment delivery, including correlating the
treatment prescription with the technical and medical
physics aspects of the treatment, and with the actual
execution of the treatment.
Appropriate modifications to the technical aspects of the
patient treatment are formulated and the medical physicist
will recommend implementation of these modifications, as
required, in a timely fashion.
77336 : Continuing Medical Physics
Consultation
• Patient status review at weekly chart rounds
• Daily planning conference
• Tumor Board
• Site specific patient review conferences
White’s Handy Guide to Radiation Oncology Procedures
ASTRO/ACR Guide to Radiation Oncology Coding
77336 : Continuing Medical Physics
Consultation
ABT Valuation
• ABT I: 1.5 hours per patient
• ABT II: 1.5 hours per patient
• ABT III: 1 hour per patient
77336 : Continuing Medical Physics
Consultation
Practices without a full-time medical
physicist must have regular on-site physics
support during hours of clinical activity at
least 2 days a week and provide 0.4 full time
equivalents (FTE) coverage.
ACR TECHNICAL STANDARD FOR THE PERFORMANCE OF RADIATION
ONCOLOGY PHYSICS FOR EXTERNAL BEAM THERAPY
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77336 : Continuing Medical Physics
Consultation
77336 : Continuing Medical Physics
Consultation
Practices without a full-time medical
on-site
physicist must have regular
physics support during hours of clinical
activity at least 2 days a week and provide
0.4 full time equivalents (FTE) coverage.
ACR TECHNICAL STANDARD FOR THE PERFORMANCE OF RADIATION
ONCOLOGY PHYSICS FOR EXTERNAL BEAM THERAPY
77336 : Continuing Medical Physics
Consultation
• Billed once every 5 fractions of treatment
(routine external beam course)
– Group by 5 fractions or on a specified day each week
• Rule: Divide by 5, round to nearest integer
– 18 fx: 4 instances of 77336
– 17 fx: 3 instances of 77336
77336 : Continuing Medical Physics Consultation
-Documentation
• Documentation of these services should include
a signed and dated indication by the medical
physicist in the patient’s chart that the continuing
medical physics consultation has been done.
ASTRO/ACR Guide to Radiation Oncology Coding
• Electronic Charts ease this process
• Treatment course of 1 or 2 fractions
– 1 instance of 77336
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77336 : Continuing Medical Physics Consultation
-EDITS
Can I Get Paid Now?
• Note numerous CCI edits, but a modifier is
allowed for many
• Confusion regarding IMRT and 77336- CCI edit
with no allowed modifiers
– Applies to the IMRT planning process (77301), not
the treatment delivery process
Annual Revenue 77336
Patients per
week
25
ABT Hours
MFS Annual $
25
$59,800
Hopps Annual
$
$135,200
50
50
$119,600
$279,400
75
75
$179,400
$405,600
100
100
$239,200
$540,800
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HOPPS Valuation
• Based on Hospital Charges
• Reduced by Cost to Charge Ratio
• Generally single charge events
• Review your Department Charge Master
• Be aware of the local Cost to Charge Ratio
• Estimate the time and resources
necessary to perform 77336 for a typical
patient.
MFS Payment Calculation
• Payment Calculation
MFS Valuation
• Subject to new calculation methodology
• Subject to changes in the Conversion
Factor
– Total RVU = (Work RVU * Work GPCI)
+ (PE RVU * PE GPCI)
+ (PLI RVU * PLI GPCI)
• Total Payment = Total RVU * $$Conversion
HOPPS Valuation
– Sustainable Growth Rate calculation
problems
Factor
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MFS Valuation
MFS Valuation – AAPM role
• Increased value will depend on a re-evaluation
of the underlying work effort of the Medical
Physicist, consistent with current practice and
ABT reports
• Recognition of increased complexity since initial
valuation
• CMS acceptance of current AAPM Salary
Survey levels
• Appropriate allocation of MP time
MFS Valuation – MP role
• Personally perform the tasks associated with
77336
• Appropriate on-site presence in all practice
settings
• Encourage peer compliance with MP effort in
77336
• Patience
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