Oncology & Hematology Coding Alert

Examples fine-tune your claims

Use this short quiz to see if you are up to speed on reporting multiple radiation treatments on the same day.
 
Example 1: Your radiation oncologist administers complex portal arrangements via photons using 11-MeV radiation to each of the three separate treatment areas. These are your options:

A. Report one unit of 77414 (Radiation treatment delivery ... 11-19 MeV) to denote the complete radiation treatment session.
B. Report three units of 77414 to signify the three treatment areas to which your oncologist delivered 11 MeV. 
C. Report one unit of 77412 (... three or more separate treatment areas ...; up to 5 MeV), one unit of 77413 (... 6-10 MeV) and one unit of 77414 to achieve the total 33 MeV administered.

The answer is A. Because the oncologist administered the radiation to three treatment areas during one session and not during "completely different" sessions, you should report only one unit of 77414.  Example 2: The radiation oncologist administers 6 MeV to a patient's neck using a custom shielding technique at 7 a.m. At 4 p.m. on the same day, he administers an additional photon treatment at 6 MeV to the patient's neck using a smaller open-portal arrangement. Which of the following codes should you report?

A. One unit of 77404 (Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11-19 MeV) because your oncologist combined the initial 6-MeV dosage to the second 6 MeV on a single treatment area, thus totaling 12 MeV.

B. One unit of 77413 (... 6-10 MeV) for the morning session and one unit of 77403 (... 6-10 MeV) for the afternoon, both based on the energy and beam-modifying devices used for each of the two separate sessions.

C. Two units of 77408 to represent two separate sessions of 6-MeV radiation treatment administered to two treatment areas.

The answer is B. The radiation oncologist maintained a six-hour break and performed the type of service that he would normally perform on separate days. Therefore, you should consider each session independently and report your physician's services based on the treatment's energy and complexity.

You would also report 77413 (because of the complex blocking) for the morning session and 77403 (single area open portals) for the afternoon session at the appropriate energy levels.

Remember: Medicare considers 77403 a component of 77413. But you can differentiate between the physician's services by attaching modifier -59 (Distinct procedural service) to the appropriate code.