Oncology & Hematology Coding Alert
4 FAQs Will Clear Up These Radiology Oncology Coding Mishaps
Here’s the difference between basic and special dosimetry. Are you struggling to report radiology oncology claims? You’re not alone. If you miss any of the details, your claim could land in limbo—which is why you need to get your claim right the first time around. Check out these four common radiology oncology questions and answers, and you’ll find your way to ethical reimbursement. Find Out What Treatment Level Constitutes Each Planning Code Question 1: Before the procedure, how do I determine what level of treatment constitutes which planning code? Many codes exist that prepare the patient for radiology. These include treatment planning and simulations. Of these, the common codes you will use are 77261-77263. Note their descriptors below: Treatment planning involves isolating cancerous areas of the body that will be treated. Knowing how many areas of the body are affected will tip you off on which code to use. For example, if only one area of the body is being treated, the planning is considered simple and therefore, you should use code 77261. For two areas of the body, you will use code 77262. For three or more, you will use the final code 77263. Because planning is a crucial part of preparing for radiology procedures, these codes are invaluable in your oncology coding arsenal. Another range of pre-treatment codes to keep in mind is 77280-77290. These codes are simulation codes, which refer to the procedure an oncologist performs to maximize the benefits of radiology while minimizing damage to the patient. Simulations are necessary and need to be coded. Refer to the list for their descriptors: 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. Differentiate Dosimetry Vs. 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). A dosimetry is a way in which the oncologist calculates the right dose for the radiation therapy. This process can isolate the type of cancer that needs treatment and can also identify what stage it is in. Because these factors are essential for a successful procedure, you should know this code inside and out. A related code, though not used as 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 their reason for the special dosimetry. Define Simple, Intermediate, and 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: 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 that, 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 that targets three or more areas of the body. In this case, specialized blocking shields are created to accommodate an individual patient’s needs. These are extremely common codes that you should familiarize yourself with. 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 that this is a common practice since the oncologist also monitors the effect of the treatments so their adjustments can yield the best results. Be sure your provider documents their direct involvement in all procedures related to a week of treatment management, including at least one progress note documenting continued medical care and review of appropriate records and port films during each week of ongoing treatment. 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 that you should keep in mind for short treatment cycles. Note: this code should not be used to be reimbursed for one or two fractions at the end of a long course of therapy.
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