How to Differentiate Between the Levels of Treatment Planning
Published on Sat Jan 01, 2000
Planning treatment for patients set to undergo radiation therapy is a complex task, but deciding how to properly bill clinical treatment planning often leaves the biller confused over which code to use. Often characteristics of planning resemble intermediate treatment planning when it could be correctly billed as complex treatment planning, and revenue gets lost.
Treatment plans themselves can be used to determine and document when a complex set of treatment considerations for radiation oncology has graduated to more complex handling, says Cindy Parman, CPC, CPC-H, and principal at CSI Coding Services, a Dallas, Ga.-based medical coding consulting firm that includes radiation oncology offices. Practices will still need to gauge the array of services planned to determine the complexity of treatment. But she says theres no reason to opt for a lower code to avoid overbilling with CPT 2000s careful discourse on the components to the clinical treatment planning process.
Parman first points to the new CPT 2000 manual, whose guidelines should be in place for most carriers by next spring. According to the manual, the clinical treatment planning process is defined as the interpretation of special testing, tumor localization, treatment volume determination, treatment time and dosage determination, treatment modality, the number and size of treatment ports, and selection of the appropriate treatment devices. Three CPT codes apply: 77261 (therapeutic radiology treatment planning; simple); 77262 (therapeutic radiology treatment planning; intermediate); and 77263 (therapeutic radiology treatment planning; complex).
Choosing Between Simple, Intermediate and Complex
While most practices can easily determine when the simple treatment planning code (77261) applies, differentiating between intermediate (77262) and complex (77263) tends to be trickier, she says. One of the biggest problems is [the absence of a] separate treatment planning record, she says.
This often leaves the biller with having to search through the entire medical record to determine which tests and procedures were ordered during the treatment planning process. The potential for missing items is increased without a central area in which the biller can go to gauge the level of clinical treatment planning complexity.
Parman recommends that practices keep a log to track clinical treatment planning where consultation notes, prescriptions, simulation notes, and block design can be easily found. Roberta Anne Strohl, RN, MN, AOCN, clinical specialist, radiation oncology at the University of Maryland in Baltimore, agrees. Anything that makes going through the patient record easier is good. Radiation oncologists at the University of Maryland routinely sit down with billing staff to review the record and the physician chooses the appropriate clinical treatment planning code, Strohl says.
Once a practice gets into the habit of listing clinical treatment characteristics on a centralized form they will garner a more accurate picture of what physicians planned for and [...]
