In simple words: This code describes a complex type of radiation treatment where the doctor uses a computer to precisely target the radiation to the tumor. This minimizes the amount of radiation to healthy tissue.The treatment uses advanced technology, and sometimes includes real-time imaging during the treatment to ensure accuracy. The code covers the machine and technology used, not the doctor's planning or supervision.

This CPT code, 77386, represents the technical component of complex intensity-modulated radiation therapy (IMRT) delivery.It encompasses the use of advanced computer-based optimization techniques to deliver non-uniform radiation beam intensities, creating highly conformal dose distributions.The complexity is defined by factors such as the treatment site, the use of techniques beyond simple physical compensator-based IMRT, and the incorporation of image-guided radiation therapy (IGRT) for guidance and tracking. The technical component of IGRT is included; however, the professional component requires separate reporting using CPT code 77387 with modifier 26.

Example 1: A patient with locally advanced lung cancer undergoes complex IMRT treatment involving multiple treatment fields, compensators, and IGRT for precise targeting and motion management.The treatment plan requires sophisticated dose calculation and optimization techniques., A patient with a large, irregularly shaped pelvic tumor receives complex IMRT treatment using a combination of techniques, such as dynamic multileaf collimation and intensity modulation, to conform the dose to the tumor while sparing adjacent critical structures (like bowel and bladder)., A patient with head and neck cancer undergoes complex IMRT with daily image guidance using cone-beam CT, ensuring accurate beam delivery and accounting for daily variations in tumor position and anatomy. The complex nature is due to the critical organs at risk in this area.

Comprehensive documentation is required, including the treatment plan (with justification for IMRT and complexity level), imaging studies used for target delineation and IGRT (including image registration details), treatment parameters (beam arrangements, dose prescription, and fractionation schedule), and daily treatment records confirming accurate delivery.

** The complexity level of IMRT treatment is determined based on various factors.Always refer to the most up-to-date CPT manual for complete coding guidelines and to ensure accurate coding practices.