Oncology & Hematology Coding Alert

Bonus: This commonly overlooked code is worth more than $100

The National Correct Coding Initiative added edits in July telling you when not to report 77321 and 77336 with G0173. But do you know when you should report these codes? We-ve broken down the requirements so you can file these claims with confidence.

Get Your G0173 Ducks in a Row

You should report G0173 for delivery of stereotactic radiosurgery (SRS) using a linear accelerator, when the patient receives the entire course of therapy in one session at a hospital.
 
The session includes placing and removing a halo, reviewing images, and determining the treatment plan.
 
Opportunity: If your physician removes a halo placed by another physician, you may report the removal with 20665 (Removal of tongs or halo applied by another physician). Hospitals get a separate allowance for this code, as well. Medicare pays more than $100 for the code for both facilities and non-facilities.

Watch for: HCPCS 2006 deleted SRS planning code G0338 (Linear accelerator based stereotactic radiosurgery plan ...), and CMS instructed hospitals to report existing codes for planning services instead, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.
 
Try this: You should report SRS planning like a one-day 3-D simulation/plan with code 77295 (Therapeutic radiology simulation-aided field setting; 3-dimensional), she says. Remember: Because all of the services are performed on the same day, you should stay alert for more services bundled with 77295, such as CT guidance (76370), teletherapy isodose planning (77305-77315), and other simulation-aided field setting services (77280-77290).

Size Up 77321, 77336 Documentation Do-s

Code 77321 (Special teletherapy port plan, particles, hemibody, total body): To report this code, you need documentation that the radiation oncologist directly participated in ordering, calibrating, and providing any other services required for the special teletherapy port plan. You also need proof of medical necessity.
 
Payer policies typically state that you can't report 77321 unless you have a printed plan signed by the physician and physicist, Parman says.
 
Tip: Don't fall prey to the common mistake of reporting this code automatically for electron services, Parman says.
 
Code 77336 (Continuing medical physics consultation ...): The radiation oncologist orders the procedure described by this code, but a physicist (or dosimetrist under physicist supervision) performs it. In a hospital setting, you should not report this technical-only code for your physician group -- the facility claims it. If you work for a freestanding center and have thorough documentation from the physicist that he reviewed and made recommendations for all aspects of the patient's care, you may report this code.
 
Many payers cover this code -- which states -reported per week of therapy- -- once for every five therapy fractions. 
 
Tip: You must have a documented physics review during each five-fraction week of therapy to support this code. Best bet: Create a weekly physics review chart document for the physicist to check off his completion of all aspects of the protocol.