Oncology & Hematology Coding Alert

Question: How do I code for the remote afterloading high-intensity brachytherapy (77781, 77782, 77783 and 77784)? What other codes can be billed with these? In addition, if the patient is getting regular beam treatment, how is it billed?

Michigan Subscriber

Answer: The codes that are billed with high dose rate (HDR) brachytherapy will depend on the services performed and documented in the patient medical record. If the HDR is combined with external beam therapy, then the possibilities for code assignment include nearly all of the services listed in the radiation oncology section of the CPT manual, 77261-77799.

There is an initial patient evaluation and management (E/M) service consultation (99251-99255), or patient exam (99201-99205) that is typically coded once per patient regardless of any combination of therapy services. Generally, there will be a treatment plan (77261-77263) and one or more brachytherapy isodose plans (77326), HDR, and surgical services for implantation of devices such as colpostats. The radiation oncologist bills only for the services rendered. If another specialist, such as a gynecologist or urologist, performs surgery, the radiation oncologist would not bill for it.

Also, the treatment plan is coded once during the course, and would typically be complex (77263) when combined modalities are applied to the tumor volume. Code 77470 (special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) would be assigned to indicate that a special service exists if combined modalities are performed. There may also be special dosimetry (77331) and special teletherapy (77321) needed when planning radiation treatment. Code 77790 (supervision, handling, loading of radiation source) would not be coded because it is bundled into the HDR codes by Medicare and most third-party payers.

Depending on the type and length of the therapy, there may also be codes assigned for simulation (77280-77295), isodose plan (77305-77315), and weekly management (77427) for fractional treatment. Code 77427 is billed only once per five fractions, regardless of whether there is external beam or HDR combined with external beam. If these procedures are provided in a freestanding center, the hospital is responsible for charging for physics consultation (77336) and 77370 (special medical radiation physics consultation), port films for external beam therapy (77417), and external beam treatment delivery.

The hospital or freestanding center will be responsible for radiation treatment delivery (77401-77416) because these services are not provided in an office setting. If you are billing for physician services only, some of the codes are for professional only, such as treatment planning and management, but others will require modifier -26 (professional component) to indicate that you are billing for the professional services as well.

Answered By Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a coding consulting firm in Dallas, Ga.