Oncology & Hematology Coding Alert

Question: What documentation is needed to bill 77470?

New Jersey Subscriber

 
Answer: Documentation must include a diagnosis of a new neoplasm and a treatment plan for a distinctly separate course of radiation therapy supporting the medical necessity.
 
Medicare is aware that 77470 (special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) may be misused. To assure carriers that you are using it correctly, physicians must document the extra time needed to handle patient care, such as concurrent radiation oncology treatment and chemotherapy.
 
Code 77470 should be used to cover additional physician effort and work required for the special procedures of hyperfractionation, total-body irradiation per oral or transvaginal cone use, brachytherapy, hyperthermia in combination with chemotherapy or other combined modality therapy, stereotactic radiosurgery, intra-operative radiation therapy and any other special time-consuming treatment plan.
 
Evidence of the above should be included in the physicians progress notes. Documentation of concurrent care is also needed when billing the technical component. The nurses notes should include much of the same information. Essentially, both technical and professional documentation should show the extra time and work needed to provide treatment.
 
Note: Modifier -26 (professional component) should be appended to 77470 to report physician involvement.
 
Answers to You Be the Coder and Reader Questions provided by Elaine Towle, CMPE, administrator for New Hampshire Oncology and Hematology in Hooksett, NH; and Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc. in Dallas, Ga.