Oncology & Hematology Coding Alert

4 Tips for Boosting Your Clinical Treatment Coding Accuracy

Published on Sat Sep 20, 2003

Here's how to report 77261-77263 and get paid

If you're not sure how to report 77261-77263 for clinical treatment planning, you're not alone. Radiation oncology coders say they're often unsure about how often they should use these codes and what documentation supports a complex radiation treatment. Follow four basic clinical treatment coding guidelines and improve your reimbursement for these services, coding experts say.

Radiation oncologists use clinical treatment planning to determine how a patient will be treated. For example, your physician may develop tumor mapping, a strategic plan, and the treatment's intent, goal and task by the time he completes the prescription for the radiation therapy, says Susan L. Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Wisconsin.

1. Report One Planning Code Per Course

Remember that you should report a clinical planning code once per treatment course. If your radiation oncologist discovers a new area of disease, say, melanoma (172.x, Malignant melanoma of skin), while treating a patient for throat neoplasm (149.x), your physician may develop a skin cancer treatment plan. In that case, you could report the appropriate clinical planning code, such as 77262 (Therapeutic radiology treatment planning; intermediate), Turney says.

But if you want to report additional treatment codes for the same patient, you should proceed with caution, says David Davis, CPC, a coding and reimbursement specialist with CEO Infinity Reimbursement and Research in Alpharetta, Ga. You should bill another code based on your physician's planning and documentation.

For instance, you should not use 77261-77263 if a patient with lung cancer (162.x) develops bone metastasis (198.5). Typically, your radiation oncologist would incorporate the metastasis into the planned radiation therapy, so you should report only one planning code, Davis says.

2. Look in Documentation for Simple or Complex Blocking

Make sure your radiation oncologist documents each aspect of clinical planning and tumor mapping. For instance, your physician should include the following in his or her documentation, says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.:

whether the treatment will require simple or complex blocking

what methods your physician plans to use to localize tumor volume

which special services, such as physics consultations, your radiation oncologist ordered

the number and size of treatment posts

which diagnostic tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) imaging scan, your radiation oncologist ordered

consultations with physicians, such as surgeons.

Also, include in the treatment plan your radiation oncologist's documentation regarding extra planning time and effort for special treatment procedures. For instance, your physician may cite intraoperative radiation therapy (IORT) (77470, Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]).

Radiation oncologists use IORT to deliver the radiation directly to the tumor sites during surgical procedures. For example, your physician may use the procedure to see and radiate locally advanced colorectal cancer (154.x, Malignant neoplasm of rectum, rectosigmoid junction, and anus), while sparing surrounding tissues.

Use 77470 for a variety of therapy modalities. For instance, Medicare carriers, such as CIGNA Medicare, consider 77470 the appropriate code for hyperfractionation, total body irradiation, per oral or transvaginal cone use, or when your physician manages other modalities, such as brachytherapy or concurrent hyperthermia, in combination with external beam therapy.

3. Report 77261 for Localized Treatment Ports

Use 77261 (... simple) when your physician's planning requires a single treatment area localized in a single port or simple parallel opposed ports, with simple or no blocking, such as planning for simple skeletal bone metastasis (198.5) treatment, Parman says.

In addition, look for these factors in the physician's documentation when choosing 77261, Parman says:

notes on superficial, orthovoltage cobalt and linear accelerator (photon) treatments

details on the treatment area, such as a malignant neoplasm in the breast (174.x).

Planning simple radiation therapy doesn't require your oncologist to interpret special tests like dosimetry (77300, Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) or to localize tumor volume.

Ratchet Up Planning Difficulty With 77262

When you think 77262 is the proper code choice, get ready to ratchet the planning difficulty up a notch. Because CPT defines this as the intermediate planning stage, you should look for a slightly more complex radiation therapy than 77261. Your physician's planning requires three or more converging ports, two separate treatment areas, multiple blocks, or special time or dose constraints, Parman says. You might report 77262 if your radiation oncologist treated a standard four-field pelvis (nonconformal) metastasis or multiple skeletal metastases in a patient with prostate cancer (185).

To report 77262, your physician's treatment must include superficial, orthovoltage cobalt, linear accelerator (photon) services, Parman says. Planning also offers a moderate level of difficulty, which usually means your radiation oncologist will treat two separate areas with three or more converging ports. During therapy your physician must protect critical or sensitive organs, such as the spinal cord or liver, which typically require multiple blocks. Your oncologist may have to interpret special tests like MRI, she adds.

4. Assign 77263 for Complex Planning

Using 77263 ( ... complex) for complex planning means you'll need to make sure that the treatment contains highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotational or special beam considerations, and a combination of therapeutic modalities, according to CPT.

Because most radiation therapy procedures, such as brachytherapy (77783, Remote afterloading high-intensity brachytherapy; 9-12 source positions or catheters), require complex levels of treatment and/or specialized technology, you will assign 77263 to most of your physician's clinical planning, Parman says.

In addition, if your physician uses a combination of external beam radiation (77401, Radiation treatment delivery, superficial and/or ortho voltage) and brachytherapy (77783) to treat the same disease, you should report the clinical planning code (77263) only once. But if different oncologists in different practices or facilities perform the brachytherapy and external beam radiation, then each physician may submit a planning charge.

Suppose your radiation oncologist plans to treat a patient with pancreatic cancer (157.x) using simple brachytherapy (77781, Remote afterloading high-intensity brachytherapy; 1-4 source positions or catheters). To protect the patient's kidney and small intestine from radiation damage, your physician must use special planning to localize the treatment area. Also, your oncologist will have to interpret complex tests, such as MRI, CT scans and other laboratory tests, Parman says. For this kind of plan, you should assign 77263.