Oncology & Hematology Coding Alert

Question: If the oncologist treats multiple fields using IMRT in a single session, should I report more than one unit of 77418?

Colorado Subscriber

Answer: No. You should report 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session) once per session. The code definition specifies that the code applies to "single or multiple fields/arcs ... per session."

CPT Assistant (March 2010) addresses a similar question in its Coding Consultation section and explains that reporting 77418 more than once per session would be inappropriate.

Smart move: Take extra care to be sure you're reporting 77418 properly. A Florida physician group recently agreed (without admitting wrong-doing) to pay the government $12 million to settle a case involving fraud allegations, including the use of IMRT in cases when the government maintains lower-priced standard radiation treatment would have worked just as well. With such a high-profile case in the news, there's a good chance auditors will be keeping an eye out for IMRT coding mistakes. You can do your part by being sure your coding accurately reflects the documentation. (The Department of Justice press release on the case is available at www.justice.gov/opa/pr/2010/March/10-civ-299.html.)

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Los Angeles-based Sinaiko Healthcare Consulting Inc.