2025 CPT code 77262
(Active) Effective Date: N/A Radiation Oncology Treatment Planning - Radiation Oncology Radiology Feed
Therapeutic radiology treatment planning; intermediate.
Modifiers may be applicable to this code in certain circumstances, such as if the service is reduced or discontinued.For example, modifier 52 may be used if the service is significantly reduced, and modifier 53 may be used if the procedure is discontinued due to circumstances beyond the physician's control.It is essential to consult modifier guidelines and payer-specific rules for appropriate modifier usage.
Medical necessity for intermediate treatment planning is established when the patient's condition requires radiation therapy to two separate treatment areas.This may be due to the presence of multiple tumors, the spread of cancer to different regions, or the complex location of a tumor requiring precise targeting. The medical record must clearly document the diagnosis, stage of cancer, and the rationale for the selected treatment approach, including the need for two distinct treatment areas.
The radiation oncologist is responsible for the clinical treatment planning process.This includes reviewing the patient's medical history, imaging studies, and other relevant information to determine the optimal treatment plan.They determine the target volume, the appropriate dose of radiation, the number and location of treatment ports, and the type of radiation therapy to be used.They also oversee the simulation process and ensure that the treatment plan is delivered accurately and safely.The radiation oncologist also manages the patient's care throughout the course of treatment, including monitoring for side effects and making adjustments to the treatment plan as needed.
In simple words: This code covers the planning of radiation therapy for two separate areas of the body. It involves deciding where the radiation beams will enter, how to protect healthy tissues, and the best type of radiation to use.It's a moderately complex procedure that takes into account the location and size of the tumor to minimize harm to surrounding healthy areas.
This code represents intermediate-level treatment planning for radiation therapy. It involves the design and implementation of a radiation treatment plan for two separate, non-contiguous treatment areas. This includes determining the location and number of ports (entry points for radiation beams), the design and placement of shielding blocks to protect healthy tissues, and the selection of appropriate treatment modalities (e.g., superficial orthovoltage, cobalt, linear accelerator, or photon services). The process also involves interpreting special tests, like MRI, to accurately localize the tumor volume and define the target area.Multiple blocks are used to shield critical organs, and special time-dose constraints may be necessary.
Example 1: A patient with two separate skin cancers on different parts of the body (e.g., one on the arm and one on the leg) may require intermediate treatment planning to target both areas effectively while minimizing damage to surrounding healthy skin., A patient with cancer that has spread to two different lymph node regions may require intermediate treatment planning to deliver radiation to both areas effectively., A patient with a tumor in a complex location, such as near the spinal cord, may require intermediate treatment planning to carefully target the tumor while minimizing the risk of damage to the spinal cord.
Documentation should include details of the treatment planning process, such as the number and location of treatment ports, the type and energy of radiation used, the total dose of radiation delivered, the use of any shielding blocks or other devices, and any special considerations related to the patient's anatomy or medical condition.The medical necessity of the treatment should also be documented, including the diagnosis, the stage of the cancer, and the rationale for choosing radiation therapy.