2018 New Radiation Coding Rules



2018 New Radiation Coding RulesRadiation Coding ScenariosPlease use the codes in the slides to complete the radiation coding scenarios below. The Phase I codes may be used to assign the Phase II and Phase 3 data items. Coding scenarios should be completed prior to the webinar. The radiation summaries in cases 1-6 are directly from radiation charts. We will review the cases during the webinar.Case 1-OropharynxTreatment Dates: 1/22/18-2/10/18Site: Head & NeckDose: 70 Gy in 35 fractions over 50 elapsed days.Techniques: IMRT in the 6 MV linear accelerator with Aquaplast immobilization and custom blocking with daily KV image guidance. FieldsCodeRationaleReason no Radiation0Radiation GivenRadiation Start Date20180122Radiation End Date20180210Phase I Radiation Primary Treatment Volume22OropharynxPhase I Radiation to Draining Lymph Nodes03Cervical lnsPhase I Treatment Modality02EBRT, 6 mv photonsPhase I EBRT Planning Technique05IMRTPhase I Dose per Fraction00200200 cGy (70 Gy/35 x 100=200 cGy)Phase I Number of Fractions03535 fractionsPhase I Total Dose00700070 Gy=7000 cGyPhase II Radiation Primary Treatment VolumePhase II Radiation to Draining Lymph NodesPhase II Treatment ModalityPhase II EBRT Planning TechniquePhase II Dose per FractionPhase II Number of FractionsPhase II Total DosePhase III Radiation Primary Treatment VolumePhase III Radiation to Draining Lymph NodesPhase III Treatment ModalityPhase III EBRT Planning TechniquePhase III Dose per FractionPhase III Number of FractionsPhase III Total DoseNumber of Phases of Radiation Treatment to this Volume011 phaseRadiation Discontinued Early01Treatment completedTotal Dose00700070 Gy=7000 cGyCase 2- ProstateSummary of I-125 seed implant: On 1/21/18, 66 iodine-125 seeds were implanted into the prostate gland/seminal vesicles with an activity of 0.245 mci/seed. He then received daily external beam therapy using intensity modulation and daily image guiding as outlined below: Treatment SiteEnergyDose/Fx (Gy)# FxDose Correction (Gy)Total Dose (Gy)Start DateEnd DateElapsed Days1-PROSV IMRT6X1.530/300452/11/183/23/18412-SV BST6X1.55/507.53/24/183/31/187Total52.52/11/183/31/1849 FieldsCodeRationaleReason no Radiation0Radiation Start Date20180121Radiation End Date20180331Phase I Radiation Primary Treatment Volume64Prostate &/or seminal vesiclesPhase I Radiation to Draining Lymph Nodes00Phase I Treatment Modality10I-125 brachytx, interstitial LDRPhase I EBRT Planning Technique88NA-no phase 1 EBRTPhase I Dose per Fraction99998BrachytherapyPhase I Number of Fractions0011 fractionPhase I Total Dose999998BrachytherapyPhase II Radiation Primary Treatment Volume64Prostate &/or seminal vesiclesPhase II Radiation to Draining Lymph Nodes00Phase II Treatment Modality02External beam, assuming 6X=photonsPhase II EBRT Planning Technique05IMRTPhase II Dose per Fraction001501.5 Gy=150 cGyPhase II Number of Fractions03030 fractionsPhase II Total Dose00450045 Gy=4500 cGyPhase III Radiation Primary Treatment Volume64Prostate &/or seminal vesiclesPhase III Radiation to Draining Lymph Nodes00Phase III Treatment Modality02External beam, assuming 6X=photonsPhase III EBRT Planning Technique05IMRTPhase III Dose per Fraction001501.5 Gy=150 cGyPhase III Number of Fractions0055 fractionsPhase III Total Dose0007507.5 Gy=750 cGyNumber of Phases of Radiation Treatment to this Volume033 phasesRadiation Discontinued Early01Radiation completedTotal Dose999998Brachytx & EBRT, instructions for Total Dose state not to add theseCase 3- Lung, Palliative for Stage IIIA T2aN2M0Treatment SiteEnergyDose/Fx (Gy)# FxDose Correction (Gy)Total Dose (Gy)Start DateEnd DateElapsed Days1-Mediastinum6X45/50202/11/182/17/186Total202/11/182/17/186 FieldsCodeRationaleReason no Radiation0Radiation Start Date20180211Radiation End Date20180217Phase I Radiation Primary Treatment Volume02Mediastinum-Thoracic LN regsPhase I Radiation to Draining Lymph Nodes88NA-LN primary tx volumePhase I Treatment Modality02EBRT, assuming 6X=6 mv photonsPhase I EBRT Planning Technique01EBRT, NOSPhase I Dose per Fraction004004 Gy=400 cGyPhase I Number of Fractions0055 fractionsPhase I Total Dose00200020 Gy=2000 cGyPhase II Radiation Primary Treatment VolumePhase II Radiation to Draining Lymph NodesPhase II Treatment ModalityPhase II EBRT Planning TechniquePhase II Dose per FractionPhase II Number of FractionsPhase II Total DosePhase III Radiation Primary Treatment VolumePhase III Radiation to Draining Lymph NodesPhase III Treatment ModalityPhase III EBRT Planning TechniquePhase III Dose per FractionPhase III Number of FractionsPhase III Total DoseNumber of Phases of Radiation Treatment to this Volume011 phaseRadiation Discontinued Early01Radiation completedTotal Dose00200020 Gy=2000 cGyCase 4- Lung Stage IV T3N2M1bTreatment SiteEnergyDose/Fx (Gy)# FxTotal Dose (Gy)Start DateEnd DateElapsed Days2 L4-SI10X/6X310/10301/7/181/20/18131 Lt Hip15X/6X310/10301/7/181/20/18133 Rt Lung6X1.835/35631/25/184/1/1867Total1/7/184/1/1885 FieldsCodeRationaleReason no Radiation0Radiation Start Date20180107Radiation End Date20180401Phase I Radiation Primary Treatment Volume30Right Lung, instructions state if multiple discreet volumes consider XRT to primary site as Phase 1Phase I Radiation to Draining Lymph Nodes00Phase I Treatment Modality02EBRT photons, assuming 6X=photonsPhase I EBRT Planning Technique01EBRT, nosPhase I Dose per Fraction001801.8 Gy=180 cGyPhase I Number of Fractions03535 fractionsPhase I Total Dose00630063 Gy=6300Phase II Radiation Primary Treatment Volume81Spine/SacroiliacPhase II Radiation to Draining Lymph Nodes00Phase II Treatment Modality02EBRT photons, assuming 10X/6X=photonsPhase II EBRT Planning Technique01EBRT, nosPhase II Dose per Fraction003003 Gy=300 cGyPhase II Number of Fractions01010 fractionsPhase II Total Dose00300030 Gy=3000 cGyPhase III Radiation Primary Treatment Volume84Left hipPhase III Radiation to Draining Lymph Nodes00Phase III Treatment Modality02EBRT photons, assuming 15X/6X=photonsPhase III EBRT Planning Technique01EBRT, nosPhase III Dose per Fraction003003 Gy=300 cGyPhase III Number of Fractions01010 fractionsPhase III Total Dose00300030 Gy=3000 cGyNumber of Phases of Radiation Treatment to this Volume033 phasesRadiation Discontinued Early01Radiation treatment completedTotal Dose999998Multiple volumes (metastatic sites) treated simultaneouslyCase 5- CervixTreatment SiteEnergyDose/Fx (Gy)# FxTotal Dose (Gy)Start DateEnd DateElapsed Days1-Pelvis10X/6X1.828/2850.42/1/183/9/1837Vag HDRI-1926.03/318.03/15/183/22/188 FieldsCodeRationaleReason no Radiation0Radiation Start Date20180201Radiation End Date20180322Phase I Radiation Primary Treatment Volume71Uterus or cervix, instructions state not to use pelvis, nos code unless primary subsite is not a pelvic organPhase I Radiation to Draining Lymph Nodes06Assuming pelvic field includes pelvic nodesPhase I Treatment Modality02EBRT photons, assuming 10X/6X=photonsPhase I EBRT Planning Technique01EBRT, NOSPhase I Dose per Fraction001801.8 Gy=180 cGyPhase I Number of Fractions02828 fractionsPhase I Total Dose00504050.4 Gy=5040 cGyPhase II Radiation Primary Treatment Volume71Uterus or cervixPhase II Radiation to Draining Lymph Nodes00Phase II Treatment Modality09Intracavitary HDRPhase II EBRT Planning Technique88Tx not EBRTPhase II Dose per Fraction99998BrachytherapyPhase II Number of Fractions0033 fractionsPhase II Total Dose999998BrachytherapyPhase III Radiation Primary Treatment VolumePhase III Radiation to Draining Lymph NodesPhase III Treatment ModalityPhase III EBRT Planning TechniquePhase III Dose per FractionPhase III Number of FractionsPhase III Total DoseNumber of Phases of Radiation Treatment to this Volume022 phasesRadiation Discontinued Early01Radiation treatment completedTotal Dose999998Brachytx & EBRT, instructions for Total Dose state not to add theseCase 6-BreastTreatment SiteEnergyDose/Fx (Gy)#FxTotal Dose (Gy)Start DateEnd DateElapsed Days2R SCF6X/10X1.828/2850.46/22/188/3/18421 R WB6X1.828/2850.46/22/188/3/18423 R B Scar Bst6E25/5108/4/188/10/1864 R Axilla Bst12E25/5108/4/188/10/186Total6/22/188/10/1849 FieldsCodeRationaleReason no Radiation0Radiation Start Date20180622Radiation End Date20180810Phase I Radiation Primary Treatment Volume40Whole BreastPhase I Radiation to Draining Lymph Nodes04Supraclavicular (SCF)Phase I Treatment Modality02EBRT photons assuming 6X/10X=photonsPhase I EBRT Planning Technique01EBRT, NOSPhase I Dose per Fraction001801.8 Gy=180cGyPhase I Number of Fractions02828 fractionsPhase I Total Dose00504050.4 Gy=5040 cGyPhase II Radiation Primary Treatment Volume41Breast partial (scar)Phase II Radiation to Draining Lymph Nodes04R Axilla Boost (Bst)Phase II Treatment Modality04EBRT, electronsPhase II EBRT Planning Technique01EBRT, NOSPhase II Dose per Fraction002002 Gy=200 cGyPhase II Number of Fractions0055 fractionsPhase II Total Dose00100010 Gy=1000 cGyPhase III Radiation Primary Treatment VolumePhase III Radiation to Draining Lymph NodesPhase III Treatment ModalityPhase III EBRT Planning TechniquePhase III Dose per FractionPhase III Number of FractionsPhase III Total DoseNumber of Phases of Radiation Treatment to this Volume022 phasesRadiation Discontinued Early01Tx completedTotal Dose0060405040 cGy + 1000 cGy=6040 cGy ................
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