Patient BT is a 15 year old who presented with abdominal pain and his PCP referred him to St

Jude after mass was seen on CT scan. After workup, BT was diagnosed with Stage IV Wilms
tumor. He had Right side Nephrectomy at Our facility and was subsequently referred to both
Medical Oncology and Radiation Oncology. BT was to receive treatment to the entire Lung, Liver
and Rt Kidney bed and was to receive a boost to the Liver for metastatic disease.
BT was covered under his parents insurance which is Blue Shield of Tennessee. Most of the
Charges billed were covered by his insurance with the exception of the IMRT boost plan. Initially,
he started with a 3D plan to the Liver, Right flank and Bilateral Lungs, then a Cone down to the
Bilateral Lung and Liver and Liver only. An IMRT boost was done to treat Metastatic disease to
the Liver.
This charges were accurate and charges were only generated on procedures performed. Some
charges were excluded like, 4D MRI and 4DCT which were used for target delineation. The
reimbursement status on the account is listed as partially paid for. The IMRT plan was challenged
by Blue Cross. However, since our department does not pass any costs to our patients who cannot
pay, those charges were absorbed by the department.
The billing were accurate with the exemption of the charges that were missing. For example daily
cone beam used during the IMRT treatment were not charged to the patient. Since the department
get a lot of donations, they can afford to not burden patients and their families.
The most alarming thing I noticed was the amount of legitimate charges that were not billed by
the department. I did ask the Director the reason for the missed charges and was told, the
machines were donated by a family trust and some of the families specifically did not want
patients charged.
The only concern I have is the amount of charges that the department did not bill for. This takes
a big hit on the department budget and make upgrades on necessary equipments depended on
donations. If an economic down turn ever happens, I am not sure how they may sustain to run the
department and balance their books. Again, they have been in existence since 1962 and have not
had any issues.

CPT Code

Description

Quantity

77334
77334
77290
77263
77470
77295
77334
77300
77336
77338
77301
77412
77386
77417

Tx Device Complex Vac loc

Tx Device Complex Mold/Cast
Simulation:C
PF Clinical Tx Plan:C
Special Treatment Procedure
3D Treatment Plan
MLC Treatment Device
Basic Calcs
Med Physics Weekly Checks
Complex IMRT Plan
IMRT Plan
Tx Complex > 1Mev
Complex IMRT Treatment
Port film

1
1
1
1
1
1
8
8
X4
1
1
13
6
13