As long as you work with low dose RT, it should be no issue.
For PVNS we generally give 35/2.5, however there is some literature pointing out that 20 Gy is fine too.
www.ncbi.nlm.nih.gov
Yeah, I was doing a small lit search when we were deciding a dose. Have tended to do a lot more 40Gy/20 for PVNS. Iirc I found some dosimetry papers showing radiation synovectomy gives a dose to the synovium of about 25 Gy, with responses also showing at about half the dose, so ended up with 20 Gy in context of the PVNS data.For PVNS we generally give 35/2.5, however there is some literature pointing out that 20 Gy is fine too.
Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years - PubMed
Postoperative external beam radiotherapy is an effective and acceptable modality to prevent local recurrence and preserve joint function in patients with diffuse PVNS of the knee. Low-dose (20 Gy) radiotherapy appears to be as effective as moderate-dose treatment (around 35 Gy).
Are you saying that an ICD-10 dx M code precludes Medicare paying for RT. E.g., plantar fasciitis is an ICD-10 M code for which RT is universally well established, historically paid for... as is Dupuytren's too I believe... is the alternative just use equivalent ICD-9 codes. MOD: perhaps this is better for the "other" forum.
It's almost reasonable to think about counseling such patients to keep that part of their history silent in talking to other non-radiation medicine physicians so they don't get medically inappropriately "radiodiscriminated" against.
If you look at all the German literature, some patients do go on to get their hips/knees done after RT and there's never been a single negative report. However if there were a hardware failure and the patient had received ~3 Gy to the joint, that failure would be wholly ascribed to the RT versus any of the other usual and/or random reasons joints fail. IMHO that'd be predictable, and wrong. In oncological situations where we give ~45-50Gy to a site preop, I'm not sure there's convincing data that such intentional, high dose preop RT leads to worse surgical outcomes than patients who get same-operated on sans RT (but postop RT shows a worser* trend). There's actually good data that doses in the ~3Gy range to the whole body or large parts of the body get completely forgiven... straight from Hall: "Heavily irradiated survivors of accidents in the nuclear industry have been followed for many years; their medical history mirrors that of any aging population. A high incidence of shortened lifespan, early malignancies after a short latency, and rapidly progressing cataracts have not been observed." Finally NASA studies human radiation exposure a lot, and their "musculoskeletal" published guidance on doses in the 1-5 Gy range essentially says there's no data (one way or the other) to show any bad long term effects.
Use C49.9. Argue that you are inducing a sarcoma anyway, so it's fine to bill for that beforehand.
I'm doing 5 x 60 cGy. I've been doing QD and was going to change if my results weren't as good as the Germans' QOD dosing, but it appears they're pretty similar. Easier for patients and staff to schedule QD.
What diagnosis are you using and is this reimbursed same as number of fx?
Analogous to "ablation" technologies (HIFU is approved for ablation of prostate tissue-no mention of cancer)
I use whichever arthritis code is appropriate and haven’t had problems with that approach.
