Daily IGRT for DIBH technique?

[Bequerel]

How do you all image your DIBH breast patients (if you have no gating system)? Do you do weekly port? Daily MV image? Daily kv imaging (if so, what do you align too?) or daily CBCT? If daily IGRT, do insurance companies give you trouble? Does daily MV tangent count as IGRT? Thanks!

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[BobbyHeenan]

I do a verification with a gate triggered DIBH set of orthogonal kV images and port films. Then, for at least the first week of treatment I take a daily gate-triggered portal tangent at least for the first week to make sure our alignment is OK.

I don't bill it as a G6002 code though. I think some people do bill that but I don't.

I have a friend in practice without gating and I believe she takes a daily DIBH MV portal image of a tangent and does not bill for this.

 

[Bequerel]

I do a verification with a gate triggered DIBH set of orthogonal kV images and port films. Then, for at least the first week of treatment I take a daily gate-triggered portal tangent at least for the first week to make sure our alignment is OK.

I don't bill it as a G6002 code though. I think some people do bill that but I don't.

I have a friend in practice without gating and I believe she takes a daily DIBH MV portal image of a tangent and does not bill for this.

Is a daily MV tangent film billable as IGRT?

 

[RadRadRad]

Is a daily MV tangent film billable as IGRT?

Daily port alone is not billable as igrt.

 

[BobbyHeenan]

Daily port alone is not billable as igrt.

I agree with this.

I *think* the two options for IGRT professional fee billing are 77014-26 (CBCT) or G6002 ("stereoscopic imaging" - which I interpret as an orthogonal pair, not just a port film).