| EYE PLAQUE BRACHYTHERAPY | ||||||||||
| RADIATION ONCOLOGY: | ||||||||||
| CLINICAL BRACHYTHERAPY: | ||||||||||
| TREATMENT PLANNING (New course only) (Circle Level) | SIMULATON, ORTHOGONAL FILMS, etc. | 3D SIMULATION AND/OR VISUALIZATION | BASIC DOSIMETRY CALCULATION | BRACHY. ISODOSE PLAN (Circle Level) | TREATMENT DEVICE (Cirle Level) | SPECIAL DOSIMETRY | SPECIAL TRMT PROCEDURE | MANUAL LOADING, HANDLING OF RADIOELEMENT | ||
| 77261 Simple | CPT 77290-26 | 77326-26 Simple | 77332-26 Simple | |||||||
| 77262 Intermediate | CPT 77295-26 | CPT 77300-26 | 77327-26 Intermediate | 77333-26 Intermediate | CPT 77470 | CPT 77331 | CPT 77790-26 | |||
| 77263 Complex | 77328-26 Complex | 77334-26 Complex | ||||||||
| Date | ||||||||||
| Date | ||||||||||
| IMPLANT PROCEDURE: | ||||||||||
| BRACHY CPT CODES | CONVENTIONAL PROCEDURE PERFORMED | EYE PLAQUE | ||||||||
| DATE | DATE | |||||||||
| 77761-26: Intracav., Simple | ||||||||||
| 77762-26: Intracav., Intermediate | ||||||||||
| 77763-26: Intracav., Complex | ||||||||||
| 77776-26: Interstitial Simple | ||||||||||
| 77777-26: Interstitial Intermediate | ||||||||||
| 77778-26: Interstitial Complex | ||||||||||
| OPHTHALMOLOGIST: | ||||||||||
| 0190T Placement of intraocular radiation source applicator | ||||||||||
| (use in conjunction with 67036) | ||||||||||