Oncology & Hematology Coding Alert

Don't report a liquid radioactive source code for seeds In addition to the initial visit and treatment planning for prostate brachytherapy, you should know how to report the pre-implant simulation, the isodose plan, the brachytherapy procedure, and post-treatment planning.

If you do not know how to code for each of these encounters, your oncology office risks misreporting, which could lead to lost reimbursement or worse - an audit.

Last month, we looked at the first two stages of brachytherapy coding: the patient's initial encounter with the oncologist and treatment planning. Read on for the second half of our prostate brachytherapy coding clinic. Pre-Implant Sim Is Complex When the oncologist performs volume and mapping services before inserting the catheters for prostate seeds, you should report 76873 (Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]). After the volume and mapping services are complete, the oncologist is ready to perform the next two steps in brachytherapy treatment: brachytherapy source verification and isodose calculations.

The physician achieves the source verification with a simulation, says Sandy McMaster, outpatient oncology financial specialist at Edward Cancer & Radiation Centers in Lisle, Ill.

There are four simulation codes to choose from; however, you'll report prostate brachytherapy source verification with 77290 (Therapeutic radiology simulation-aided field setting; complex), says Cindy Parman, CPC, CPC-H, RCC, president elect of the AAPC National Advisory Board and co-founder of Coding Strategies Inc., in Dallas, Ga. Other Sim Levels Have Codes, Too There are codes for the other levels of simulations, but you likely won't use them in prostate brachytherapy, Parman says. For example, let's say your oncologist conducts a simulation on one treatment area using a single port or parallel-opposed ports. This is a simple sim, which you would report with 77280 (...simple).
For two separate treatment areas with three or more converging ports, report 77285 (...intermediate).
 
Note: You do not use 77280 or 77285 in prostate brachytherapy scenarios, Parman says. "While 77280, in the form of a verification simulation, is used for other types of brachytherapy, neither of these simulation codes are used for prostate seeds," she says

3-D Sim Rare But Possible: You may be able to report a three-dimensional simulation in certain instances with CPT code 77295 (... three-dimensional), according to CPT.
 
"The reporting of a 3-D simulation/plan with prostate seed brachytherapy varies based on individual payer guidelines," Parman says. "For example, Wisconsin Physician Services (WPS) Medicare states: '3-D reconstruction of tumor volume and critical structure volume in brachytherapy cases to develop a DVH.' "

When coding for a 3-D sim, you should report 77295.

You may need modifier -26: If your oncologist performs any type of simulation in a hospital setting, you must append modifier -26 (Professional component) to the simulation code. The hospital will [...]