Patient CU is a 39 year old female diagnosed with T1 N2 M0 invasive mammary

carcinoma of the right breast. The patient was treated after a mastectomy and chemotherapy. CU
was treated with a four-field chest wall technique to include bolus and non-bolus chest wall
tangents and opposed supraclavicular fields. The prescribed dose to the supraclavicular and axilla
nodes was 5000cGy in 25 fractions at 200cGy per day using 6MV and 23MV photons. The
prescribed dose to the right chest wall was 5000cGy in 25 fractions at 200cGy per day using
6MV and 23MV photons. The prescribed dose for the electron scar boost was 1000cGy in 5
fractions at 200cGy per day with 9MeV electrons.
CU is insured by South Carolina Public Employee Benefit Authority (PEBA). The
patients account is paid in full. Self Regional Healthcare has a contract with PEBA in which
60% of the charges are written off for those insured by PEBA. The patient had already met her
out of pocket maximum for the year due to the mastectomy and chemotherapy, therefore PEBA
covered the portion that wasnt written off and the patient didnt pay anything out of pocket for
radiation therapy services provided. Please see the table below for the current procedural
terminology (CPT) codes billed to the patients account for radiation therapy related services.
Code
99245

Description
Physician Consult

Number of Instances
1

(pre-treatment consult,
99213

45min)
Nursing Facility Fee

(30min consult)
77290

Complex Simulation

(computer aided simulation

77014

from CT simulation)
CT-guidance for field

placement
(technical charge for the
77263

hospital for CT equipment)

Complex Treatment Plan

(initial simulation)
99211

Nursing Facility Fee

(10 min check up)

77300

Basic Dosimetry

20

Calculation
(MU second check)
77295

3D Planning

77334

Complex Treatment Device

20

(MLC field shaping and

77280

electron block)
Verification Simulation

77412

Complex Treatment

30

Delivery
77417

Port Verification

(electronic port image)

77336

Continuing Physics

(chart checks)
77321

Special Isodose Teletherapy

(Technical charge for the

facility and professional
charge for the physician
77427

choosing an electron energy)

Physician Treatment

Management
(Physician weekly check up
99214

for patients under treatment)

Physician Follow Up
(45 min follow up
appointment after treatment

was complete)
I reviewed this chart with Kim Hartzog, the chief therapist at Self Regional Healthcare
Cancer Center (oral communication, November 20, 2015). The large number of basic dosimetry
calculation (77300) and complex treatment device (77334) charges is due to the amount of
treatment fields from the use of a field-in-field technique on the chest wall tangents. During the
chart audit, I found that three Port Verification charges, 77417, had not been charged. Hartzog
verified that the port verification images had been taken and adjusted the charges accordingly. I
found the rest of the charges to be accurate.