Oncology & Hematology Coding Alert

Number of sources determines several coding choices Last issue, we discussed coding for prostate brachytherapy beginning with an initial E/M service, through treatment planning and possible volume studies and special treatment procedures. To report the full course of treatment accurately, you-ll need to continue a step-by-step coding approach. Read on for more expert tips to help you succeed. Simulation Calls for 77280-77295 Following treatment planning (77261-77263) for prostate brachytherapy, the oncologist may obtain images (x-ray film) of the targeted treatment area -- to define and adjust dose calculations -- and of the eventual position of the brachytherapy seeds. For this service, you should select an appropriate simulation code (77280-77290). "The initial simulation may be reported as a complex simulation (77290, Therapeutic radiology simulation-aided field setting; complex) when it requires AP and lateral orthogonal films and contrast," Empire Medicare, Part B Carrier for New York and New Jersey, states in its local coverage determination for prostate brachytherapy. In contrast, you would report three-dimensional MRI or CT-based simulations with dose volume histograms and dose cloud preparation using 77295 (-3-dimensional). Note: You would not report 72290 and 77295 together. "Real-time" 3D planning (72295), which occurs at the same time as placement of the brachytherapy seeds, bundles 77290 on the same date. Additionally, you may report 77280 (-simple) for verification simulations during treatment, says Janae Ballard, CPC, CPC-H, CPC-E/M, PCS, FCS, ACS-EM, revenue coding analyst at Virginia Mason Medical Center in Seattle. You may need modifier 26: If your oncologist performs any type of simulation in a facility setting, you must append modifier 26 to the simulation code to show that he provided the "professional" portion of the service only. Count Sources for Isodose Planning Code Next, the physician will order an isodose plan, which determines the dose at each implanted source and throughout the treatment volume, as well as the doses to surrounding normal tissue. Depending on the number of sources the physician specifies, you will select:
- 77326 -- Brachytherapy isodose plan; simple [calculation made from single plane, one to four sources/ribbon application, remote afterloading brachytherapy, 1 to 8 sources])
(for eight sources or fewer)
- 77327 -- ... intermediate [multiplane dosage calculations, application involving 5 to 10 sources/ribbons, remote afterloading brachytherapy, 9 to 12 sources) (for 9-12 sources)
- 77328 -- ...complex [multiplane isodose plan, volume implant calculations, over 10 sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over 12 sources]) (for more than 12 sources). Tip: A typical course of brachytherapy should require no more than three isodose plans. Documentation should reflect medical necessity for additional units of service. For instance, the physician may need additional calculations to determine decay or point dose calculations. Keep Watch for Separate Dosimetry Calculations Brachytherapy requires dosimetry calculations prior to (and during) the [...]