Oncology & Hematology Coding Alert

Question: I want to report the planning of radiation treatment but the codes are divided by simple, intermediate, and complex. The oncologist worked on two areas, the pelvis and multiple skeletal metastases. Is this simple, intermediate, or complex?

Virginia Subscriber

Answer: This is an intermediate procedure so you will report code 77262 (Therapeutic radiology treatment planning; intermediate). An intermediate procedure is defined as the treatment of two noncontiguous treatment areas which require three or more converging ports, multiple blocks, or have special time dose constraints. A noncontiguous area is defined as areas that are close, but not connected. In your case, the pelvis and these skeletal metastases, converging at least three times, are considered noncontiguous and fulfill the requirements to be considered intermediate.

Intermediate planning also requires an oncologist to interpret specialized tests that determine tumor size. Additional planning may be required depending on the sensitivity of the affected area.

Alternatively, you report code 77261 (Therapeutic radiology treatment planning; simple) for simple radiation treatment planning. Simple planning is defined as any planning that focuses on a singular treatment area. You should know that treatment areas may be located in a single location or may be located in parallel opposed ports with no or minimal blocking. Also, the oncologist does not perform any special tests that are required in either the intermediate or complex procedures.

For complex treatment planning, you should use the code 77263 (Therapeutic radiology treatment planning; complex). Complex treatments involve the planning of chemotherapy for three or more separate treatment areas that require sophisticated peripherals like highly complex blocking, custom shielding blocks, tangential ports, special wedges, or compensators.

Complex treatment plans usually need a special test or CT/MRI localization to be conducted by your oncologist. Your oncologist may be responsible for special planning and mapping to ensure the patient’s unaffected areas are protected from damage possibly caused by the chemo. This planning satisfies the condition for a complex service and is usually performed whether the patient is in early or advanced stages of cancer.

Be careful not to bill for multiple treatment plans. Your oncologist may consider to use special treatments like rotational or special beam plans and may be tempted to bundle these plans. You cannot bill for multiple treatment plans in a single course of treatment. A good rule of thumb is to only report one treatment planning once per radiation course.