Oncology & Hematology Coding Alert

Question: Should we bill follow-up visits immediately following intensity-modulated radiation treatment (IMRT) procedures?

South Dakota Subscriber

Answer: When coding for IMRT (77301, Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications), you should follow CPT's introduction to the radiation oncology section that states that radiation oncology services include follow-up care during the course of treatment and for three months following the treatment's completion.
 
Also, Chapter 18 of the American Society for Therapeutic Radiology and Oncology/American College of Radiology User's Guide lists all items that are  included in the weekly treatment management and not separately payable. This list includes a specific reference to "follow-up examination and care for 90 days after last treatment (whatever code billed)."
 
CMS updates the global surgery status list each year; however, this list generally refers to surgical services that include a 10- or 90-day follow-up period as part of the total surgical package. Remember that the absence of a nonsurgical code on this list does not necessarily imply that you should abandon the requirements of the CPT definitions or the ASTRO/ACR guidelines.

 - Answers to Reader Questions and You Be the Coder were reviewed by Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.