CG-MED-38 Inpatient Admission for Radiation Therapy for Cervical or Thyroid Cancer Form

This document addresses the medical necessity of an inpatient admission for radiation treatment for cervical and thyroid cancer. Radiation implants, also called brachytherapy, may be placed in interstitial or intracavitary spaces for the treatment of cervical cancer. Thyroid cancer may be treated with radioactive iodine such as I-131. Individuals are discharged from the hospital after the radiation implants are removed and the levels of radioactivity are deemed safe and appropriate for discharge.

Note:

• This document does not address the use of I-131, a radioactive substance when used as a diagnostic tool in an I-131 scan.
• Federal or State regulations will supersede the guideline Length of Stay included under both Clinical Indications section and Goal Length of Stay (GLOS) sections.

Clinical Indications

Medically Necessary:

An inpatient admission for radiation treatment for cervical or thyroid cancer is considered medically necessary for the period of time the individual’s calculated level of radioactivity is greater than the discharge guidelines set by the U.S. Nuclear Regulatory Commission (USNRC, 2020). See Appendix A.

Not Medically Necessary:

An inpatient admission for radiation treatment for cervical cancer or thyroid cancer is considered not medically necessary when the above criteria are not met.

Goal Length of Stay

Goal Length of Stay:

Coding