Download NCAT Coding Guide for Radiotherapy (External Beam

Guidance for Radiotherapy OPCS 4.5
This guidance has been developed by clinical members of the radiotherapy coding group to support
consistent interpretation of the OPCS 4.5 codes in clinical practice.
The guidance allows radiotherapy services to have a standard interpretation when relating this
guidance to individual techniques or clinical delivery.
It is recognised that it is valid for the majority of all techniques.
In some circumstances; local delivery may mean that teams may wish to amend this guidance.
Planning / Preparation codes
Definition of Preparation(X67 code) includes:
 Simulator and or CT planning
 Volume delineation, localisation and outlining
 Creation of treatment plan
 Treatment plan authorisation
 Pre treatment verification
Code
X67.1
X67.2
X67.3
X67.4
X67.5
X67.6
X67.7
Definition
Includes full inverse planned IMRT (with
or without patient specific QA
measurements).
Clinical Delivery examples
 All Inverse planned IMRT treatments
(Excludes forward planned IMRT except
with specific patient QA)
Would include
Excludes forward-planned IMRT unless
o Rapid Arc
this involves patient-specific QA
o V.Mat
o Cyberknife
Use:
Y91.1 (serial Imaging)
Y91.4 ( IGRT – i.e. adaptive with CBCT)
 TBI
 Hemi body
Includes production of isodose
 Non conformal radiotherapy
distribution using a treatment planning
 CT planned open fields (e.g. 3 or 4 field
system that does not include beam
brick)
shaping devices (MLCs or Pb) (with or
 Virtual sim with isodose distribution
without imaging)
 Tangential breast
 Larynx
Not involving production of an isodose distribution
 AP fields
using a treatment planning
 Lateral brain/neck
system (with or without imaging)
 Single fields
 Mark-up on set
Treatment delivered not using a linac or
 SXR
cobalt unit
Production of an isodose distribution
 Conformal with MLCs (prostate; lung;
using a treatment planning system that
breast; H&N)
includes beam shaping devices (MLCs
 Linac based stereotactic
or Pb). May include forward-planned
 Respiratory gating
IMRT without patient-specific QA but all
techniques involving patient-specific QA
should be coded as X67.1
Page 1 of 4
Technical Support (this can only be used in conjunction with a planning / preparation code)
Y92.1
This code can be recorded in addition to any preparation code as required and
relates to the manufacture of patient specific devices i.e.
 immobilisation device includes e.g.: Impression and shell fitting
 beam shaping device
Delivery codes
X65.4
Must be used for all external beam RT with the exception of TBI – use in
conjunction with one of the Y codes below.
Y91.1
Complex
Includes delivery that
involves significant serial
imaging for systematic errors
e.g. Any volume with
matched planes, fields with
Lead, Multi field plans.



Significant Serial Imaging
Anything not in 91.2 or 91.3 or 91.4
Planned Electrons
Y91.2
Simple
Includes geometric
verification, Parallel pairs,
single photon and electron
fields, simple breast
techniques, 2 field larynx
technique
Includes multiple area
palliative patients
Kilovoltage units only



Single field mets
Parallel pair – palliative
Single electron (e.g. breast boost / soft
tissue mass etc)
3 or 4 field palliative
Any other simple technique that does not
require serial imaging.

Anything using orthovoltage
Delivery of the fraction
includes production of a
three-dimensional image
(e.g. cone-beam CT or
ultrasound) so that the field
position may be changed at
the time of treatment if
necessary

Anything using IGRT with/without multiple
plans
Cyberknife
Anything using fiducial markers to guide
radiotherapy delivery
Y91.3
Orthovoltage
Y91.4
Adaptive




Notes:






IVD does not change coding to be used.
Serial Imaging is as defined in ‘On target’ protocols. See section 7
Codes are generated by each prescription
Codes are generated on intent – not outcome
A future code for true adaptive treatment needs to be introduced to
incorporate the use of multiple plans
Worked examples given in Annex 1 and 2
This guidance was prepared in January 2011 by the following:
Jan Balyckyi – The Marsden
Christine Richards – Maidstone
Jenny Tomes – Norfolk and Norwich
Annex 1
Stephen Tozer-Loft – Sheffield
Kath Walker – Addenbrookes
Tim Cooper - NCAT
Page 2 of 4
Worked Example 1 – Head and Neck
Head and Neck:
Ant with matched opposed fields plus electron boost.
CT planned
MLCs
Shell
Electron cut-out
Field
Prescription
Planning code
Additional
Planning code
Delivery
Code
Ant Neck
Prescription 1
X67.5
X92.1 –
Technical
Support
X65.4
Y91.2
(Mould room)
Opposed fields
Prescription 2
X67.7
X65.4
Y91.1
Opposed fields
Phase II
Prescription 5
Matched
electron field R
Neck
Prescription 3
Matched
electron field L
Neck
X67.7
X65.4
Y91.1
X67.7
(if done without
using TPS – then
X67.5)
Prescription 4
X67.7
(if done without
using TPS – then
X67.5)
Page 3 of 4
X92.1 –
Technical
Support
X65.4
Y91.1
(Electron cut
out)
X92.1 –
Technical
Support
(Electron cut
out)
X65.4
Y91.1
Annex 2
Worked Example – Breast
Breast:
Post Op breast radiotherapy
Tangential breast fields
CT planned with SCF
Electron boost with patient specific cut-out
Forward planned IMRT
Field
Prescription
Planning code
Additional
Planning code
Delivery
Code
Tangential
breast
Prescription 1
X67.7
X92.1 –
Technical
Support
X65.4
(if not IMRT then
X67.4)
Y91.1
(Mould room)
SCF
Electron boost
Prescription 2
Prescription 3
X67.7
X65.4
(if not IMRT then
X67.5)
Y91.1
X92.1 –
Technical
Support
X67.5
(Electron cut
out)
Page 4 of 4
X65.4
Y91.2