Oncology & Hematology Coding Alert

Question: In a patient who had secondaries in the brain, new bone secondaries are diagnosed. Can we bill for CT planning for both the sites? Please also advise for the number of units of 77295 that we can report.

New Mexico Subscriber

Answer: The inquiry states there are two different secondary neoplasm sites in the case example. Therefore, the oncologist would request separate sets of CTs for each separate location. 3D planning will also be different for the two sites, i.e., bone and brain. Make sure your oncologist documents the tumor volume and the other structures that will need protection during the radiation treatment. Also, ensure there is documentation for the medical necessity of each 3D plan.

You report a single unit of 77295 (3-dimensional radiotherapy plan, including dose-volume histograms) when your oncologist uses the same CT data-sets to plan the two sets of treatments. This is because the anatomy and the tumor volume do not typically change for the highest dose regions throughout the course of treatment. Thus, larger “nodal” volumes and smaller “cone-down” volumes can be generated using different beam angles such that a single cumulative dose distribution is reported for the two plans.