Oncology & Hematology Coding Alert

As Medicare continues to scale back payment for the time-intensive, complex work involved in prostate brachytherapy the transperineal implantation of permanent radioisotope seeds it's more imperative than ever before for radiation oncology coders to know proper coding strategies for each component. Code Brachytherapy Step by Step "When you are coding a radiation procedure like brachytherapy, you must keep in mind each of the distinct steps involved," says Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm. "In most cases, you will be able to assign codes that may include consultation, treatment planning, treatment simulation, dosimetry calculations and isodose planning, and, sometimes, additional special services." Step 1: Consultation Radiation oncologists usually spend a lot of time with a patient who has been referred for a consultation, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC in Indianapolis. "This is the time a physician would spend with the patient prior to deciding whether or not to treat," he says. "This consultation, which usually comes from the urologist, would encompass elements outlined in medical or surgical E/M service codes."                      

Parman reminds readers of the definition of consultation: It's a request from one physician to another physician for an opinion or advice. If the patient is sent so the doctor can "evaluate and treat," then it is a new patient visit. Hause tells coders that if documented counseling and coordination of care comprises more than 50 percent of the time the radiation oncologist spends face-to-face with the patient as it often does then time would determine the E/M level billed.

Due to the intensity of this visit, if the service was completely documented, it would almost always be assigned the most extensive CPT code, 99205 (New patient; office or other outpatient visit) or 99245 (Office consultation for a new or established patient). Step 2: Clinical Treatment Planning Once radiation oncologists decide to treat the prostate cancer patient with brachytherapy, Hause says, they will embark on an in-depth treatment planning process. The process includes interpretation of special testing that may have been done, prostate localization, and other procedures. "The vast majority of brachytherapy treatment plans will be coded 77263 (Therapeutic radiology treatment planning; complex)," he says. The American Medical Association added a new code to CPT in 2000 to describe an additional study done in brachytherapy treatment planning. The urologist or the radiation oncologist may perform 76873 (Echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]). "It's for volume and mapping, and gives the physician an idea of where to insert the catheter for the prostate seeds," says Craig McNabb, MBA, BSN, reimbursement manager for radiation for the Atlanta branch office of US Oncology, based [...]