Oncology & Hematology Coding Alert

Here’s the difference between basic dosimetry and special dosimetry.

Oncology coding can blur the lines of radiology and related procedures, which means you’ve got to be prepared for when these claims land on your desk. Check out these subtleties and stay ahead of potential denials.

Here’s How to Decide the Level of Treatment Planning

Question 1:  Before the procedure, how do I determine what level of treatment constitutes which planning code?

Many codes exist for the preparation of a patient for radiology services. These include treatment planning and simulations. Of these, the common codes you will use are 77261-77263. Note their descriptors below:

• 77261 (Therapeutic radiology treatment planning; simple)
• 77262 (Therapeutic radiology treatment planning; intermediate)
• 77263 (Therapeutic radiology treatment planning; complex).

Treatment planning involves isolating cancerous areas of the body to be treated. Knowing how many areas of the body are affected help determine the correct code choice.

For example, if only one area of the body is being treated, you should consider the planning as simple and therefore, you should use code 77261. For two areas of the body, use code 77262. For three or more, use the final code 77263. Because planning is a crucial part of preparing for radiology procedures, these codes are valuable to keep in your oncology coding arsenal.

Another range of pre-treatment codes 77280-77290. These are simulation codes and refer to the procedure an oncologist performs to maximize the benefits of radiology while minimizing damage to the patient. Simulations are necessary. To code them accurately refer to the list for their descriptors:

• 77280 (Therapeutic radiology simulation-aided field setting; simple)
• 77285 (Therapeutic radiology simulation-aided field setting; intermediate)
• 77290 (Therapeutic radiology simulation-aided field setting; complex).

Once again, note the descriptions simple, intermediate, and complex. Simple refers to a simulation of a single area so you should code simple procedures as 77280.

For intermediate, use code 77285 when two areas are being simulated. Three or more areas are required for the procedure to be considered complex, and in situations like these, use the final code 77290.

Draw the Line Between Basic Dosimetry, Special Dosimetry

Question 2:  If a patent is receiving a dosimetry, how do I tell the difference between a basic dosimetry and a special dosimetry?

The first code you should know is 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician).

Dosimetry is a mathematical computation of the radiation dose at a particular point. Per the Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing and Allied Health, “It is used to determine the amount, rate, and distribution of radiation emitted from a source of ionizing radiation.” All dosimetry calculations must be checked, reviewed and approved by a physician. Because these factors are essential for successful procedures, know and understand this code completely.

A related code, though used less often, is a variation on the basic dosimetry found in code 77300. You can code this special dosimetry with 77331 (Special dosimetry [eg, TLD, microdosimetry] [specify], only when prescribed by the treating physician). This type of dosimetry can only be ordered by the radiation oncologist and it is easy to identify because usually the oncologist will write out the special circumstance for the special dosimetry.

Define Simple, Intermediate, Complex Procedures

Question 3: My patient is undergoing radiation treatment — how do I tell the difference between simple, intermediate, and complex procedures?

The radiation treatments can be confusing to code because, again, they are divided into simple, intermediate and complex procedures. However, because of the sheer volume of treatments that occur in every practice, it is important for you to know the codes and understand when to use each one. Keep in mind the following three codes:

• 77402 (Radiation treatment delivery, >=1 MeV; simple)
• 77407 (Radiation treatment delivery, >=1 MeV; intermediate)
• 77412 (Radiation treatment delivery, >=1 MeV; complex).

The distinction between simple, intermediate, and complex is fairly simple to remember.

Radiation treatment on one area of the body with one or two ports is considered simple. Simple also indicates, at most, two simple block shields were used. If the procedure you are coding for fills these requirements, then you need to use code 77402.

The intermediate code 77407 treats two different areas of the body. It also uses three or more ports aimed at the treated areas, with three or more blocking shields. In this case, you should use the code 77407.

The complex code 77412 describes a procedure which targets three or more areas of the body. In this case, specialized blocking shields are created to accommodate an individual patient’s needs.

Find Out When You Can Report Either 77427 or 77431

Question 4:  Two codes, 77427 and 77431, are applicable to post-treatment management. Which one should I use?

The major code you need to know is 77427 (Radiation treatment management, 5 treatments).

This type of management is used by oncologists to adjust doses for the patient, up to five sessions after the initial procedure. It is also important to know this is a common practice since the oncologist also monitors the effect of the treatments so their adjustments can yield the best results.

A second code to know is 77431 (Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only). For smaller treatments of radiation, known as fractions, the oncologist completes the course of treatment in only a few sessions. It is a variation on the former code, but one you should keep in mind for short treatment cycles.