Oncology & Hematology Coding Alert

Question: We are getting denials for the E/M procedure when done on the same day as treatment planning. Can these two codes be billed on the same day?

Kentucky Subscriber

Answer: CCI edits state that you cannot bill follow-up E/M codes (99211-99215) on the same date of service as the treatment plan but you should be able to bill consultation codes (99241-99245 and 99251-99255).

You cannot bill an E/M code on the same day as treatment planning because it would amount to a species of duplicate billing. Treatment planning (77261-77263) includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of ports, selection of appropriate treatment devices, and other procedures. This service requires the collaboration of many members of the radiation therapy team physician, dosimetrist, physicist and therapist.

However, the patient need not be present for treatment planning to be performed. A common scenario occurs when the physician sees the patient on one day and orders the radiation therapy. The physician performs the treatment planning on a subsequent day. In this case, you can bill the appropriate E/M code from the day of the visit as well as a treatment plan billed on a separate day.