Oncology & Hematology Coding Alert

Question: A consultant once told us to include 77470 with time-consuming or complex treatment planning such as for brachytherapy. Could you clarify code 77470 and how often we should report it?

New York Subscriber

Answer: According to AMA guidelines, you report 77470 (Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) for extra cognitive planning time and effort that go

above and beyond complex clinical treatment planning (77263, Therapeutic radiology treatment planning; complex). This means the physician completed a complex clinical treatment plan, then expended cognitive effort above and beyond that

plan.

Coding caution: Code 77470 is not routinely charged for any radiation service. When your claim does merit 77470, only bill it on the date documented in the medical record. As CPT states, "77470 assumes that the procedure is performed one or

more times during the course of therapy, in addition to daily or weekly patient management." Because the explanation includes "one or more times during the course of therapy," submitting it once covers your bases.