Oncology & Hematology Coding Alert

Documenting thoroughly will get oncologists reimbursed for all stages of radiation treatment planning and will help them avoid audits.

I was looking at the charts of one physician and told him, If I were an auditor, I would be getting all your simulation money back because of poor documentation, says Cindy Parman, CPC, CPC-H, principal and
co-founder of Coding Strategies Inc., a Dallas, Ga.-based coding consulting firm.

The clinical treatment planning process includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices and other procedures.

Coding and Documenting the Planning

There are three procedure codes for planning:

77261 (simple therapeutic radiology treatment
planning) Simple planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking.
77262 (intermediate) Planning requires three or more converging ports, two separate treatment areas, multiple blocks, or special time constraints.
77263 (complex) Planning requires highly
complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate areas, rotational or special beam considerations, combination of therapeutic modalities.

Proper documentation of radiation treatment planning requires radiation oncologists to reflect accurately the number of treatment areas, ports and blocks in the patient record.

Simulation Codes

There are five codes for simulation 77280-77299. As Parman explains, prior to beginning a course of treatment, a simulation is completed to determine the size and location of the initial treatment ports, which are designed to direct the radiation at tumor areas and protect critical tissue. Parman says most simulation cases call for 77290 (complex; simulation of tangential portals, three or more treatment areas, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, hyperthermia probe verification, any use of contrast materials) or 77295 (three-dimensional; computer generated three-dimensional reconstruction of tumor volume and surrounding critical normal tissue structures from direct CT scans and/or MRI data in preparation for non-coplanar or coplanar therapy. The simulation utilizes documented three-dimensional beams eye view volume-dose displays of multiple or moving beams. Documentation with three-dimensional volume reconstruction and dose distribution is required). This is due to the complexity of todays simulations, but many radiation oncologists fail to provide the correct documentation. They often neglect to make the detailed notations about the simulation that justify using 77290 or 77295.

What payers are noticing is documentation that does not show physician participation, says Parman. Radiation oncologists should keep detailed simulation notes. A simulation note, completed and signed by the radiation oncologist, should document physician participation. The simulation note should include the following:

The date the simulation was completed;
The reason for [...]