*Note there are different coding instructions in Version 4.0 CTR Guide to Coding Radiation Therapy Treatment in the STORE opposed to earlier version 3.0 regarding the recording of Accubost*
Scenario: 2022 diagnosis of breast cancer treated with lumpectomy & radiation. Radiation specifics below:
- 01/10/2022 to 01/31/2022: Tangential opposed fields to left breast, 16 fractions, 4256 Gy (commonly called “the Canadian protocol”).
- 02/01/2022 – 02/04/2021: 1000 cGy boost to surgical bed in 4 fractions using Accuboost™ technology.
Question: How would you code Phase 2 (boost) Modality and technique?
Answer:
- Phase 2 Modality =02 External beam, Photons
- Phase 2 technique= 02 Low Energy X-ray
Per CTR Guide to Coding Radiation Therapy Treatment in the STORE Version 4.0 February 2022
Example #28 Breast: Lumpectomy, External Beam, Accuboost™
Accuboost is a mechanical device that can position an iridium-192 radiation source in multiple orientations in close proximity around the exterior of the breast. Iridium-192 is a radioisotope that produces a stew of low energy x-rays (old-timers might still call them gamma rays) that, with some tungsten shielding, can form a “beam”. Marketing material describes this as “Non-invasive Breast Brachytherapy” used both for surgical bed boosts, as in this case, and for accelerated partial breast irradiation (APBI). From a STORE coding perspective, it is just another form of external beam x-ray treatment, in a class with its predecessors, radium, cobalt-60 and Cesium 137. All these have been used as both external beam sources and for interstitial or intracavitary brachytherapy. Marketing sources also refer to it as a form of brachytherapy. “Brachy” simply means” slow”. The founding fathers of radiation oncology used prefix primarily to distinguish between external beam therapy which could be completed in less than an hour (radium), half-hour (Cobalt-60 with a tired source), or 5 to 10 minutes. (linear accelerators), and implants with the same isotopes that might take 2-3 days. An Accuboost treatment takes 20-25 minutes. So, with the long tradition of “brachy” usage in mind, we would not recommend coding this as any form of brachytherapy.
Appendix B – Coding Modality for the Heavy Equipment of Modern Radiation Therapy 4.0 {note 3.0 instructions were different for Accubost, be sure to note change}
