March 2008 Coding Tip (View more 2008 Coding Tips)

Field in Field Breast vs. IMRT Breast

Questions to ask?

1. Are you doing inverse or forward planning?
2. Do you have dose constraints?
3. Do you have a goal target volume?
4. Are you doing this just to block hot spots?

If this is being done for the purpose of blocking hot spots or if the answer to questions 1, 2 or 3 is no; then this is field in field technique, which is considered external beam and not IMRT.

Billing for devices for field in field technique: If you have several different MLC patterns per field then they are billable as long as they are documented.

Billing for calculations for field in field technique: Were MU calculations done for each MLC pattern or was one calculation blended together throughout the treatment field? If separate MU calculations were done and documented (there must be documentation for each calculation along with the rest of the dosimetry) then they are all billable.