Oncology & Hematology Coding Alert

Question: May we bill for the technical component with 77300-77334? If so, what documentation do we need?

Colorado Subscriber

 
Answer: A number of services are included in 77300-77334 (medical radiation physics, dosimetry, treatment devices, and special services), and all of them include a professional and technical component.
 
Following is key information for documenting the facility component. Code 77300 (basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, as required during the course of treatment, only when prescribed by the treating physician) defines basic radiation dosimetry calculations, and the technical component of this service is represented by a calculation sheet(s) completed by the dosimetrist and/or physicist. The radiation oncologist must sign and date these calculations. Signing and dating the calculation sheet serves to bill the professional component of the services and to document that the calculations were used for patient treatment, which justifies the facility technical component billing.
 
Special dosimetry (77331) must be ordered in writing by the radiation oncologist and be medically necessary to be reimbursed. Documentation must include a report listing the method of special dosimetry employed (microdosimetry, diodes, etc.), which is signed and dated by the physician and physicist.
 
Codes 77305-77328 represent isodose plans created by the physics department at the request of the radiation oncologist, and are signed and dated by both the physicist and the physician. Documentation for the external beam isodose plans (77305-77315) and the brachytherapy isodose plans (77326-77328) is included in the patient record in the form of a printout that includes dose distribution information.
 
The special teletherapy isodose plan is similar to the special dosimetry service because it also requires a special patient-specific report requested by the radiation oncolo-gist and completed by the physicist. This service is generally medically necessary when special beams, such as electrons, are used for all or part of the treatment.
 
Codes 77332-77334 define treatment devices and are a documentation challenge for many facilities and professional practices. The simulation films will include physician drawings of devices to be constructed, but it is often difficult to produce legible copies of these films in an audit. As a result, facilities should include a treatment device form in the patient chart to record blocks constructed, as well as the use of wedges, boluses and patient positioning devices.
 
Treatment device documentation is widely audited by Medicare and commercial or managed care insurers, primarily due to the lack of medical records in many patient charts. One difference between facility and professional reimbursement for this service is that the facility is generally paid for each device constructed, but the physician may be reimbursed for each design completed. Physicians can include device design information in the treatment plan, simulation or progress notes. This is one area of radiation oncology where the facility and physician may desire to capture and maintain separate documentation, because the service is reimbursed differently to each entity. Individual payer policies vary, so make sure to verify policy with local payers for all services.