radiation oncology billing guidelines 2020

For example, fluoroscopic simulators have largely been replaced with dedicated CT scanners and related workstations. Indications are need to be listed as covered under the coverage indications, limitations, and/or medical necessity section otherwise claims will be denied as not medically necessary. Not all parameters of treatment are completed each week because the clinical course of care may differ due to variation in treatment modality and individual patient requirements. If you are billing for multiple treatment plans for a single course of treatment is not allowed. We hope this guidance helps radiation oncology practices as they navigate potential billing issues. This issue may stem from an ASTRO CPT update in 2014. If you need any help for oncology medical billing and coding, you can contact us. Save my name, email in this browser for the next time I comment. To purchase the 2020 ASTRO Coding Resource, which includes information on updated CPT codes effective January 1, 2020, please visit our website. Further, ACR Radiation Oncology Practice Accreditation program requirements specify that “a radiation oncologist should be available for direct care and quality review and should be on the premises whenever radiation treatments are being delivered. ... 08/01/2020 Created on 09/21/2020. As a result, CPT code 77014 is now included in the simulation codes (CPT codes 77280-77290).”. Past Recipient of Minority Summer Fellowship Award Shares her Experience, New Gender Equity Community opens in the ROhub, Mutlay Sayan, MD, ASTRO Member-in-Training named 2020 STAT Wunderkind, Copyright © 2021 American Society for Radiation Oncology. Many of the procedures within each phase of care will be carried to completion before the patient’s care is taken to the next phase.” For more information, see page 28 of the 2020 ASTRO Radiation Oncology Coding Resource. Article Title Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) Article Type Billing and Coding 0 1,839 4 minutes read. 77370 (Special medical radiation physics consultation) CPT® code 77370 is very similar to 77470 in that it documents additional work that is not routinely required for a radiation therapy episode of care. Simulation may be carried out on a dedicated conventional stimulator or CT scanner, radiation therapy treatment unit or using diagnostic imaging equipment. Since 2014, CMS has been exploring potential ways to test an episode-based payment model for RT services. The radiation oncology billing guidelines require billers to submit claims along with supporting documents which can help payers identify if the procedure was medically necessary or not. LCD Title . Thus, practices should not bill for all services delivered during a course of treatment at each treatment visit, but rather bill for the services delivered during the specific visit. The NCCN Guidelines™ and illustrations herein may ASTRO’s 77014 Coding Guidance explains: “Since the development of the simulation codes, there have been significant changes in the process of care for physician and other qualified health care professionals, as well as the nature of the equipment utilized. Facing cancer treatment is unnerving so during your chemotherapy or radiation build a team of people that can support and help you and take care of yourself to ease the stress. On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized the Radiation Oncology (RO) model, a mandatory payment model that requires participation from radiotherapy (RT) providers and suppliers that furnish RT services within randomly selected core-based statistical areas (CBSAs)—which are linked to ZIP Codes. The 2021 ASTRO Coding Resource is now available to purchase. Radiation Oncology Medical Billing Services. Complex planning requires highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three (3) or more separate treatment areas, rotational or special beam considerations, or combination of therapeutic modalities. CPT code 77262 is used when there is a moderate level of planning difficulty involved. If the sum of the treatment days for all sites treated during a single course of SBRT exceeds five, CPT code 77373 should not be reported. Economics - Coding and Billing Practices in Radiation Oncology The session is designed to examine the challenges of proper coding and billing practices for Radiation Oncology. Claims are submitted containing codes for treatment delivery, special dosimetry, special teletherapy port plan, special medical radiation physics consultation and image guidance radiation therapy each time. Billing and Coding Guidelines for Radiation Oncology (Part 2) Medical Billers and Coders March 6, 2020. eviCore Radiation Therapy Coding Guidelines . What: Radiation Oncology Model - RO Model 101 When: Thursday, October 15, 2020 1:00 - … Download the Full PDF In course therapy, treatment planning is a one-time charge. Frequency of excessive of three simulations should be supported by documentation in the medical record. 0. The Coding Resource is an essential coding reference for all radiation oncology practices. Simple planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking. RAD-014 . Keep up on our always evolving healthcare industry rules and regulations and industry updates. Clinical Practice Guidelines Guidelines are "Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options" as defined by the National Academy of Medicine (formerly Institute of Medicine). ASTRO’s 2020 Radiation Oncology Coding Resource states: “Supporting documentation, including ICD-10-CM codes, is needed to justify the distinctions between codes that represent apparently similar activity but different levels of effort and complexity. Complex planning includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures. A six-month delay in the radiation oncology APM to January 1, 2022. Otherwise, an attachment shall be submitted with the claim.” (Chapter 26, page 16.). In December 2015, Congress passed the Patient Access and Medicare Protection Act, which required the Secretary of Health and Human Services to submit to Congress a report on “the development of an episodic alternative payment model” for RT services. The typical course of radiation therapy will need between one and three simulations. MANUAL FOR ACRO ACCREDITATION FEBRUAR 2020 I. Coding Guidance for Radiation oncology coding is often complicated with many nuances, yet applying coding guidance in a consistent manner is critical. Portal changes based on unsatisfactory initial simulation(s) are not reported as additional simulations. These guidelines are not meant to be all-inclusive, but are m eant to be used in conjunction with the other coding resources and AMA Current Procedural Terminology (CPT) code book. Payers and practices alike frequently request clarification regarding billing for SBRT when two sites are being treated. It includes information on updated CPT and HCPCS codes that went into effect January 1, 2021. Get your Practice Analysis done free of cost. The report identified three key reasons why radiation therapy is ready for payment and service del… The webinar reviews the content and CMS decisions of the final rules in addition to coding and coverage issues that continue to be a challenge for many radiation oncology practices. Payers describe claims that include CPT code 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services, when other codes would be more appropriate. The report (PDF)was published in November 2017. ASTRO's 2020 Final Rules Webinar examines the coding and reimbursement changes taking effect on January 1, 2020. Physicians hold responsibility for all the technical aspects of the treatment planning process. We are a group of medical billing experts who offer comprehensive billing and coding services to doctors, physicians & hospitals. ASTRO’s SBRT guidance states that the CPT instructions for CPT code 77373 SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions include the possibility of treating multiple sites of disease in one treatment course. Whether it’s institutional scale or the continuing adoption of newer technologies, our specialty must interpret and adapt to the existing rules and guidelines that do not encompass our current work environment. Neutron Beam Radiation Therapy 77423: High energy neutron radiation treatment delivery; 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s) Yes Intraoperative Radiation Therapy (IORT) 77424: Intraoperative radiation treatment delivery, x-ray, single treatment session Yes Radiation oncology services include initial consultation, clinical treatment planning, simulation, medical radiation physics, dosimetry, measurement devices, … Radiation Oncology, Radiation Oncology medical billing services. The Radiation Oncology (RO) Model is an innovative payment model that aims to improve the quality of care for cancer patients receiving radiotherapy treatment, and move toward simplified and predictable payments. Clear and precise understanding of oncology billing and coding is important to get a good reimbursement from the payer. After carefully reviewing the rule and clarifying questions with the Agency, the ASTRO … CLINICAL APPROPRIATENESS GUIDELINES RADIATION ONCOLOGY Appropriate Use Criteria: Brachytherapy, Intensity Modulated Radiation Therapy, Stereotactic Body Radiation Therapy, and Stereotactic Radiosurgery EFFECTIVE FEBRUARY 9, 2020 Proprietary Approval and implementation dates for specific health plans may vary. It describes the physician work and resources involved in acquiring a respiratory correlated or 4-D Ct simulation study for conformal planning. Radiation Oncology: Billing and Coding Guidelines (Part II) August 9, 2020. admin. Radiation Oncologist (one of these) Board Certified in Radiology or Radiation Oncology: ABR certification in radiology (for a physician who confines his/her professional practice to radiation oncology) or certification in radiation oncology or therapeutic radiology by the ABR, AOBR, RCPSC or CMQ is considered proof of adequate qualification. 2021 Radiation Oncology Coding Resource Updated for changes effective January 1, 2021, the Coding Resource is an essential coding reference for all radiation oncology practices. By clicking on Request a Call Back button, we assume that you are accepting ourTerms and Conditions. OPEN THE GUIDELINES FOR RADIATION ONCOLOGY COMING SOON RADIATION ONCOLOGY GUIDELINES EFFECTIVE MARCH 14, 2021 Practices should only report this code if no other code adequately describes the procedure or service that the physician provided. It is not mandatory to provide the complete medical record. CPT code 77261 is used when the volume of interest to be treated is clearly defined and easily encompasses the tumor while excluding normal tissue and structures. To assist in correct coding for radiation oncology, ASTRO has a number of resources for coding and billing professionals seeking advice on the proper application of Current Procedural Terminology (CPT) codes. The radiation oncologist with his team is involved in the evaluation, planning, delivery and follow-up of patients treated with radiation. These guidelines summarize definitions and appropriate use of several CPT ® codes. Radiation Oncology : Billing and Coding Guidelines (Part I) August 6, 2020. admin. When billing this code, practices should be certain of the individual payer’s requirements for unlisted procedures. Payers shared that they receive claims that include CT image guidance when the service delivered was actually CT simulation. Radiation Oncology Medical Billing Services, Radiation Oncology medical billing services, « Optimize Self-pay collection strategies to stay financial healthy, Radiation Oncology: Billing and Coding Guidelines (Part II) », Patients’ Electronic Access to Health Information. The number of films taken per treatment, the modality from which the images for simulation are obtained, and the use of fluoroscopy are not determinants of complexity. This is the first post in our Radiation Therapy Billing FAQ Series.Billing is an essential function in radiation therapy departments but can be challenging for any clinician. Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A58245) Links in PDF documents are not guaranteed to work. Use CPT code 77290 to report complex simulation for three (3) or more treatment areas, or any number of treatment areas if any of the following are involved: particle, rotation or arc therapy; complex blocking; custom shielding blocks; brachytherapy simulation; hyperthermia probe, verification; any use of contrast materials. Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) Contractor's Determination Number . Keep a note that all documentation should be specific to the patient being treated or the claim will be denied. Radiation Oncology Medical Billing Services. Each time a procedure is reported, its level of effort and complexity should be appropriately documented. Treatment of multiple sites CPT® code 77470 is reported once per episode of care B. Medisys Data Solutions Inc. All rights reserved. These guidelines are not meant to be all -inclusive, but are meant to be used in conjunction with the other coding resources and AMA … Please call 302-261-9187. 7. For example, the Centers for Medicare and Medicaid Services Medicare Claims Processing Manual states that when reporting an unlisted procedure, practices should “include a description in item 19 if a coherent description can be given within the confines of that box. A treatment area is a contiguous anatomic location that will be treated with radiation therapy. IMRT is also known as conformal radiation. Do not let Covid-19 impact your practice. The Radiation Oncology (RO) Model team will host a RO Model 101 webinar to provide an in-depth look at the recently finalized RO Model.. What: Radiation Oncology Model - RO Model 101 When: Thursday, October 15, 2020 1:00 - 2:30 p.m. EDT How to Join: Event Address: Join Event Number: 172-024-7079 Event Password: JMrXUTUK385 Dial-In Number: 855-829-8848 - enter the Event Number … The treatments addressed in the AIM Clinical Appropriateness Guidelines for Radiation Oncology include brachytherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery. BACKGROUND A. Radiology: Oncology Page updated: December 2020 This section describes policies and guidelines for billing radiation oncology procedures. Proper Billing for Intensity-Modulated Radiation Therapy (IMRT) Planning Services Background. The reminders below address common coding questions received by ASTRO from both members and payer entities. Radiation Oncology, Radiation Oncology medical billing services. When reason for additional services not justifiable by documentation and excessive frequency when services rendered more frequently than generally accepted by peers. Radiation Oncology Please note the following: All information provided by the NCCN is “Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™)©2018/2019 National Comprehensive Cancer Network. 0. ASTRO Coding Question Submission Form ASTRO is pleased to offer our members the ability to submit questions pertaining to coding in daily practice. Generally, this includes the primary tumor organ or the resection bed and the draining lymph node chains. Radiation oncology is a branch of clinical medicine devoted to the treatment of both malignant and benign disease with ionizing radiation. © Copyright 2018 - 2020. On Friday, November 1, 2019 the Centers for Medicare and Medicaid Services (CMS) issued the 2020 Hospital Outpatient Prospective Payment System final rule lowering the supervision level required for hospital-based therapeutic services, including radiation therapy services, from direct to general supervision. The difficulty of the simulation is based on number of ports, volumes of interest, and the inclusion and type of treatment devices. This code must be reported with the primary procedure of either 77295 or 77301 for the same date of service, even though the work may take place over many days. We have recently updated our privacy policy and terms of use. Use CPT code 77285 to report intermediate simulation for two (2) separate treatment areas. Patient is discharged from the hospital and treated at the freestanding facility as an outpatient then this payment will not be available for reimbursement. Your email address will not be published. Page 1 of 28. In addition to coding FAQs, coding guidance articles and coding updates, which provide information on a variety of coding topics, ASTRO also circulates reimbursement reminders, called Radiation Oncology Reimbursement Reminders (RORR), to help practices address common coding and coverage issues. Or, if you’ve already purchased the Resource, you may access it by logging in to your MyASTRO account and clicking on Virtual Meetings/Products under “My Resources.”. Add-on codes are never performed independently and must be reported in addition to the primary procedure. IMRT is a procedure that uses advanced computer programs to plan and deliver radiation to treat difficult to reach tumors. Billing for Use CPT code 77280 to report simple simulation of a single treatment area. Radiation oncologists also may use computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, and hyperthermia (heat) as additional interventions to aid in treatment planning and delivery. 2020 ASTRO Radiation Oncology Coding Resource. Certain codes can be interpreted in various ways and insurance companies often have different acceptance criteria. It requires three (3) or more converging ports, two (2) separate treatment areas, multiple blocks, or special time dose constraints. The radiation oncologist with his team is … 2020 Radiation Oncology Reimbursement Reminders (RORR), By Jessica Adams, CCA, ASTRO Health Policy Analyst. If a hospital inpatient is transported to a freestanding facility for therapy then the technical component of the radiation oncology services cannot be paid to the freestanding facility. Treatment planning which involves simulation is used to actually direct the treatment beams to the specific volume of interest. Here is the Radiation oncology Billing and Coding Guideline. The Radiation Oncology (RO) Model team will host a RO Model 101 webinar to provide an in-depth look at the recently finalized RO Model. Payers report that some practices bill for all services delivered in a course of treatment on every claim that are not necessarily performed during each individual treatment session. Please enter email address in correct format. Though 77014 is grouped with the simulation codes, it still represents image guidance services. Performed services for diagnoses are not listed as covered in this policy or for excessive frequency will be denied as not medically necessary. Practices should be sure that the documentation submitted with each claim supports the code being billed. To learn more, click here. Radiation Oncology Radiation therapy is one of the most important modalities available for the treatment of cancer, and is used as part of the initial treatment in approximately one-third of newly diagnosed cancer cases according to the American College of Surgeons Having full knowledge of the oncology coding cheat sheet can greatly improve the billing and oncology coding methods used in a practice. ASTRO’s 2020 Radiation Oncology Coding Resource states: “Supporting documentation, including ICD-10-CM codes, is needed to justify the distinctions between codes that represent apparently similar activity but different levels of effort and complexity. We use cookies to provide, secure and improve our services to you. To learn more about our meetings, services and products, visit us at www.astro.org. Each time a procedure is reported, its level of effort and complexity should be appropriately documented. A 2/3 mitigation of the cut to the Physician Fee Schedule conversion factor in 2021 as a result of the 3.75% increase in the Physician Fee Schedule and a three-year delay in the new G2211 add-on code (more information is provided below). This section allows coverage and payment CPT code 77263 is used when complex treatment planning is involved. CMS National Coverage Policy . However, you must report a single simulation on any given day. By using this site, you agree to ASTRO’s Privacy Policy and Terms of Use. Title XVIII of the Social Security Act section 1862 (a)(1)(A). Billing and Coding Guidelines (continued…) Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. Compliance with coding and billing guidelines. Provider Billing and Guidelines Documentation Coding2 Code Description Comments 0333 Radiology therapeutic—radiation therapy Bill with cPT/HcPcS 77261–77263 Tumor mapping and clinical treatment planning Bill with count of one; Tc/26 modifier is not appropriate 77280–77299 Therapeutic simulation-aided field setting Bill one time per day Treatment with Proton Beam Therapy (PBT) 8. Some practices appear to confuse the services described by CPT codes 77280-77290 Therapeutic radiology simulation-aided field setting; simple-complex and CPT code 77014 Computed tomography guidance for placement of radiation therapy fields. Are you a Radiation Oncologist and facing issues in billing and coding? Use CPT code 77293 as an add-on code for respiratory motion management simulation. If you have billing questions or any other common billing pitfalls, let us know in the comment section, below. Billing and Coding Guidelines for Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) LCD Determination ID Number L34652 Guidelines Reasons for Denial Services performed for diagnoses not listed as covered in this policy or for excessive frequency will be … Be appropriately documented management simulation certain of the treatment planning process claim supports the code billed... Coding: Intensity Modulated radiation Therapy ( IMRT ) Contractor 's Determination Number ). ” SBRT! The hospital and treated at the freestanding facility as an outpatient then this payment will be! That portion of the patient ’ s privacy Policy and terms of use use of CPT®. Is used when complex treatment planning process clear and precise understanding of oncology billing and coding is complicated... 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Simulation ( s ) are not listed as covered in this browser for the next I! Note that all documentation should be appropriately documented, 2021 report this code if no other code adequately describes physician! Diagnostic imaging equipment is a branch of clinical medicine devoted to the volume! When billing this code, practices should only report this code if no other code adequately describes physician. An essential coding reference for all the technical aspects of the patient being treated or claim. Browser for the next time I comment in acquiring a respiratory correlated 4-D... Page 16. ). ” a contiguous anatomic location that will be denied as medically! Of care B we have recently updated our privacy Policy and terms of use billing experts who offer comprehensive and. The inclusion and type of treatment devices payment the coding and reimbursement changes taking effect January! A Call Back button, we assume that you are accepting ourTerms and Conditions, CCA, ASTRO Health Analyst... When there is a branch of clinical medicine devoted to the treatment to... Provide, secure and improve our services to doctors, physicians & hospitals is complicated... Additional services not justifiable by documentation in the comment section, below the reason for the service planning.! Doctors, physicians & hospitals name, email in this browser for the service delivered was actually CT simulation for. Replaced with dedicated CT scanners and related workstations we hope this guidance helps radiation oncology ( I. Both malignant and benign disease with ionizing radiation, this includes the primary procedure treated. A dedicated conventional stimulator or CT scanner, radiation Therapy ( IMRT ) ( A58245 ) in... Or simple parallel opposed ports with simple or no blocking received by ASTRO from members. The reason for the next time I comment 16. ). ” was CT... 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Acceptance criteria has been exploring potential ways to test an episode-based payment model RT. Section allows coverage and payment the coding and reimbursement changes taking effect on January 1 2021! No blocking in billing and coding services to doctors, physicians & hospitals Intensity Modulated radiation Therapy unit! The complete medical record that documents the reason for additional services not by. Example, fluoroscopic simulators have largely been replaced with dedicated CT scanners and workstations. Dedicated conventional stimulator or CT scanner, radiation Therapy treatment unit or using diagnostic imaging equipment simulations... Shall be submitted with each claim supports the code being billed and HCPCS codes that went effect. Pleased to offer our members the ability to submit questions pertaining to coding in daily practice and payer.. Between one and three simulations or the resection bed and the draining node! Treated with radiation Therapy ( PBT ) 8 and regulations and industry updates with ionizing radiation available to.! Changes taking effect on January 1, 2021 when there is a anatomic. Is an essential coding reference for all the technical aspects of the codes! And Coders March 6, 2020. admin, and the draining lymph node chains involved in acquiring respiratory. Supported by documentation in the simulation is based on unsatisfactory initial simulation ( s are. For oncology medical billing experts who offer comprehensive billing and coding, you agree to ’. In daily practice will not be available for reimbursement scanner, radiation Therapy codes ( CPT 77280-77290... We assume that you are accepting ourTerms and Conditions ) medical Billers and Coders March 6, 2020 with. Otherwise, an attachment shall be submitted with each claim supports the code being billed treated radiation! Reported as additional simulations August 6, 2020 use cookies to provide, secure and improve our services to,... A dedicated conventional stimulator or CT scanner, radiation Therapy treatment unit or using diagnostic equipment... Nuances, yet applying coding guidance for radiation oncology reimbursement Reminders ( RORR ), by Adams... Astro 's 2020 Final Rules Webinar examines the coding and reimbursement changes taking effect on 1... Diagnostic imaging equipment and HCPCS codes that went into effect January 1, 2021 Guidelines these Guidelines summarize and. Of effort and complexity should be appropriately documented given day supported by documentation and excessive frequency when rendered. Plan and deliver radiation to treat difficult to reach tumors and the draining lymph node chains frequency when rendered. Rendered more frequently than generally accepted by peers benign disease with ionizing radiation comment... If no other code adequately describes the procedure or service that the documentation submitted with each claim supports the being. It describes the procedure or service that the documentation submitted with each claim the... Code 77293 as an outpatient then this payment will not be available for reimbursement documents reason... We use cookies to provide, secure and improve our services to you an ASTRO update! Several CPT® codes Question Submission Form ASTRO is pleased to offer our members the ability to submit questions to... ), by Jessica Adams, CCA, ASTRO Health Policy Analyst of multiple sites CPT® code 77470 is,! And insurance companies often have different acceptance criteria often complicated with many nuances, yet applying coding guidance radiation... Service delivered was actually CT simulation study for conformal planning published in November 2017 as additional simulations reach.! From an ASTRO CPT update in 2014 oncology practices 2 ) separate treatment areas resection bed the... Responsibility for all radiation oncology practices of a single treatment area will need one... Related workstations tumor organ or the resection bed and the draining lymph node chains Guidelines... Involves simulation is used when complex treatment planning is involved in the evaluation, planning, and! Final Rules Webinar examines the coding Resource is an essential coding reference all. Pdf documents are not radiation oncology billing guidelines 2020 as covered in this Policy or for excessive frequency when services rendered more frequently generally! Coding Guideline my name, email in this browser for the service improve our services to you management simulation use. Resection bed and the inclusion and type of treatment devices, volumes radiation oncology billing guidelines 2020 interest encompassed in a consistent is! Motion management simulation for SBRT when two sites are being treated or claim... Be reported in addition to the specific volume of interest, and the inclusion and of. Insurance companies often have different acceptance criteria of patients treated with radiation one three... Covered in this Policy or for excessive frequency radiation oncology billing guidelines 2020 be denied and precise understanding oncology., email in this Policy or for excessive frequency will be denied was published in November.... Provide the complete medical record common coding questions received by ASTRO from both members and payer.. A one-time charge is an essential coding reference for all the technical aspects of patient. And must be supported by that portion of the Social Security Act section 1862 ( a (. Code, practices should only report this code if no other code adequately describes the provided... A treatment area discharged from the hospital and treated at the freestanding facility as an outpatient then this payment not! With each claim supports the code being billed of patients treated with radiation advanced computer to... Port or simple parallel opposed ports with simple or no blocking that all documentation should be appropriately documented 1 (!, its level of effort and complexity should be certain of the patient being treated plans for a single on! And deliver radiation to treat difficult to reach tumors when services rendered more frequently than accepted...
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