Master Multiple Radiation Treatment Coding

Use examples to clarify the issue

Still not clear on the rules for coding multiple radiation treatments? Check out these examples and determine which of the possible coding options is correct.
Example 1: The physician administers complex portal arrangements via photons using 11-MeV radiation to each of the three separate treatment areas. These are your options:
A. Report one unit of 77414 (Radiation treatment delivery ...; 11-19 MeV) to denote the complete radiation treatment session.
B. Report three units of 77414 to signify the three treatment areas to which the physician delivered 11 MeV.
C. Report one unit of 77412 (... three or more separate treatment areas ...; up to 5 MeV), one unit of 77413 (... 6-10 MeV) and one unit of 77414 to achieve the total 33 MeV administered.
 
The answer is A. Because the physician administered the radiation to all three treatment areas during one session and not during "completely different" sessions, you should report only one unit of 77414. 

Example 2: The physician administers 6 MeV to a patient's neck using a custom shielding technique at 7 a.m. At 4 p.m. on the same day, he administers an additional photon treatment at 6 MeV to the patient's neck using a smaller open-portal arrangement. Which of the following codes should you report?
A. One unit of 77404 (... 11-19 MeV) because the physician combined the initial 6-MeV dosage with the second 6 MeV on a single treatment area, thus totaling 12 MeV.
B. One unit of 77413 for the morning session and one unit of 77403 for the afternoon, both based on the energy and beam-modifying devices used for each of the two separate sessions.
C. Two units of 77408 to represent two separate sessions of 6-MeV radiation treatment administered to two treatment areas.
 
The answer is B. Because the physician maintained a six-hour break and performed the type of service that he would normally perform on separate days, you can consider each session independently and report your services based on the energy and complexity of the treatment. You would report 77413 (because of the complex blocking) for the morning session and 77403 (single area open portals) for the afternoon session at the appropriate energy levels.

And, you should not "add up" the amount of energy the physician administered (as was the case in option "A") to total a higher level of MeV than your machine is capable of delivering.

- Published on 2004-05-17