January 2008 Coding Tip (View Coding Tip Archive)

Is it appropriate to bill a 3D Simulation (77295) for brachytherapy planning?

Yes, 3D Simulation is considered to be “medically necessary” under certain conditions. One of which is to manipulate source positions and activities to develop a three-dimensional dose distribution for the tumor, with the need to carefully limit the dose to adjacent critical structures.

The three pieces of documentation needed to support the 3D Simulation (77295) code would be:

1. Dose Volume Histogram (DVH)

2. 3D picture of the volume of interest with critical structures

3. the isodose plan

The documentation should be signed and dated by the dosimetrist, physicist and the physicians to designate approval of the plan