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Oncology & Hematology Coding Alert

Dont Let Special Handicap Your Payment:

Show Payers Dynamite Documentation

Published on Sun Jun 01, 2003

What's so special about your physician's work? If payers can't answer this question from your documentation, then you have no medical justification for claiming that your service is beyond routine and deserves payment because it is.

The name of the game for getting these services paid is documentation that shows the services are indeed "special," says Cindy Parman, CPC, CPC-H, RCC, at Coding Strategies Inc. Special services for radiological oncologists have their unique requirements, but one thing's true for all of them: Avoid "cloned documentation" with a 10-foot pole.

The phenomenon of cloned notes is one of the most recent coding plagues infecting every medical specialty. Cloned notes those from day to day or from patient to patient may lead to denials and recoupments for overpayments, says Georgette Gustin, CPC, CCS-P, CHC, director of PricewaterhouseCoopers in Indianapolis. You don't want your physician's notes for one patient to look exactly like the notes for every other patient with that condition, she says. Documentation instead should be patient-specific, she says.

That means you should avoid large amounts of preprinted text on your physician's notes and circled templates, especially for services that are "special" or unique to the type of service, Parman adds. These four services raise the bar for medical necessity because you have to prove they're above and beyond the routine services of its type.

  • Special Teletherapy: According to Parman, payment for 77321 (Special teletherapy port plan, particles, hemibody, total body) requires:
  • the direct involvement of the radiation oncologist
  • a statement in the medical report that says it is part of the isodose plan
  • that you do not automatically bill it, and only in certain circumstances do you report 77321 as a basic calculation.
  • Special Dosimetry: You must establish medical necessity when you report 77331 (Special dosimetry [e.g., TLD, microdosimetry] [specify], only when prescribed by the treating physician). Medical necessity for this service requires:
  • a written request by the radiation oncologist
  • the presence of hermoluminescent dosimetry, microdosimetry, film dosimetry, solid-state diode, or other methods of measuring specific dosage
  • documentation for the special radiation measuring and monitoring devices used, such as solid-state diode probes
  • hard-copy documentation of the measurements with additional notes regarding the measuring devices used, which the physicist and radiation oncologist must sign
  • results that serve to accept or modify the current treatment plan, Parman says. Add to this last requirement these two qualifications: The physician doesn't routinely use 77331 for a patient under treatment and doesn't request 77331 as a quality-assurance measure, she says.

    Reporting this service should be reserved for complex clinical treatment planning in which the physician measures the amount of radiation a patient has received. Reporting special dosimetry is similar to reporting simple dosimetry. The number of times you report 77331 depends on the number of ports used to deliver radiation. The results determine whether to continue with a treatment plan or to modify it.

    Individual payer policies may vary regarding proper coding and reimbursement for special dosimetry. Some Medicare carriers allow you to report 77331 for each field monitored, while others reimburse 77331 once per course of treatment.

    Some payers may also request documentation of the calculations with the diagnosis information. Documentation should clearly explain how special dosimetry will impact the patient's current treatment plan.

  • Special Physics Consultation: To report 77370 (Special medical radiation physics consultation), you must show that this consultation is for a specific procedure in specific circumstances for example, for a pregnant patient, multiple overlapping treatment areas, or retreatment of the same site, Parman says. You must include a written request by the radiation oncologist for a service that requires a physicist's, and not just a dosimetrist's, expertise. You must also include the summary report.
  • Special Treatment Procedures: If you automatically report 77470 (Special treatment procedures [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) with chemotherapy, you won't see payment for this code.

    This treatment planning must justifiably be "special," which you can ensure with documentation of the following that apply, Parman says:
  • total body irradiation (TBI) or hemibody
  • per oral
  • vaginal cone
  • hyperfractions
  • certain brachytherapy
  • intraoperative therapy
  • concurrent chemotherapy
  • stereotactic treatment
  • concurrent multiple-site treatments
  • retreatment of the same site.

    You should also ensure your physician documents the extra time he or she spends organizing the treatment plan. In addition, you should apply other appropriate radiation treatment management codes, such as radiation treatment management codes 77427-77432 and 77499 (Unlisted procedure, therapeutic radiology treatment management).

    You typically shouldn't assign 77470, Parman states:

  • when radiation therapy follows chemotherapy (unless a payer specifically allows it) 
  • when chemotherapy follows radiation therapy (unless a payer specifically allows it)
  • with hormone therapy
  • with all 3-D simulations.
  • A note on bundling: You should never report 77321, 77331, 77370 and 77470 on the same day that you report 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) to Medicare. The National Correct Coding Initiative (NCCI) edits bundle these listed codes and others into 77301, and you can't unbundle the last three listed codes with modifier -59 (Distinct procedural service).

     

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