Oncology & Hematology Coding Alert

Question: When a course of therapy involves both brachytherapy and external beam therapy, should I report two separate treatment planning codes?New Jersey SubscriberAnswer: No. If you check CPT's "Clinical Treatment Planning (External and Internal Sources)" guidelines, the definition of complex planning includes "combination of therapeutic modalities."Your New Jersey Medicare Part B contractor, Highmark, specifies that "Treatment planning is a one-time charge per course of therapy. Billing for multiple treatment plans for a single course of treatment is not allowed." This information is in Highmark's "Radiation Therapy Services" local coverage determination (L27515).The policy explains that 77263 (Therapeutic radiology treatment planning; complex) is appropriate "when complex treatment planning is involved. Three or more volumes of interest may require treatment. Planning includes interpreting complex tests such as MR and/or CT localization of tumor(s). The cancer is generally complex in its distribution regardless of whether the patient is in early or advanced stages of [...]