Oncology & Hematology Coding Alert

When a particularly difficult case of cancer is treated with a regimen of chemo-therapy and radiation, the radiation oncologist providing the treatment planning may be inclined to code 77470 code 77470 (special treatment procedure [e.g., total body irradiation, hemibody irradiation, per oral, endocavitary or intraoperative cone radiation]). This code recognizes the clinical management by a physician for a patient receiving special procedures. In this case, however, it would usually be more accurate to bill for normal radiation treatment planning or the actual procedure.

The special treatment code, 77470, is commonly reimbursed by payers, but can easily be misused. If you can document that special treatment planning was used, you should have no problem getting paid, says Carl Bogardus, MD, FACR, president of Cancer Care Network, a billing and coding consulting firm in Midwest City, Okla. Yet, the rules associated with the code are confusing and lack clear direction, he adds.

According to Medicare regulations, 77470 covers the additional physician effort and work required for the special procedures of hyperfractionation, total body irradiation, per oral or transvaginal cone use, brachytherapy, hyperthermia, combination with chemotherapy or other combined modality therapy, stereotactic radiosurgery, intraoperative radiation therapy, and any other special time-consuming plan.

The code is normally used along with other radiation treatment management codes, such as 77427-77432 and 77499. In addition to the reimbursement for these codes, 77470 carries a 2.09 RVU for physicians, which translates into about $80.

For example, 77470 can be used when treating children with radiation therapy, because of the extra time and planning it takes to prepare a child, says Jim Hugh, MHA, senior vice president with AMAC, a reimbursement and billing firm based in Atlanta that serves radiation oncology practices and hospitals.

Two other examples are:

Total body irradiation (TBI),
Hemibody irradiation (HBI), per oral, endocavitary or intraoperative cone irradiation.

TBI requires the delivery of radiation throughout the body, while HBI focuses on half the body. Like radiation to specific sites, total body and hemibody irradiation fall under the radiation treatment delivery codes, 77401-77417; clinical treatment planning, 77261-77263; and simulation, 77280-77295. Both procedures require an extensive amount of planning to ensure the proper dose is delivered and that damage to major structures is avoided; therefore, Medicare allows the use of 77470 to be billed with the appropriate planning, simulation and radiation treatment codes.

This code should not be used to simply account for extra time used, warns Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies in Dallas, Ga. It should be used under the following circumstances:

1. Proton therapy. Append it to the listed treatment planning code when proton therapy is used as the main course of therapy, or as [...]