Oncology & Hematology Coding Alert

See beam radiation treatment, too? Stop leaving reimbursement on the table

You-ve got some vocabulary to learn if you want to bring home the $600 paid for 77763 services. Don't worry. Our experts break down intracavitary codes to boost your coding accuracy in no time flat.

Count Sources to Choose Code Level

CPT lists three codes specifically for intracavitary brachytherapy:

       - 77761 - Intracavitary radiation source application; simple

       - 77762 - - intermediate

       - 77763 - - complex.

You should choose the proper intracavitary code based on the number of sources or ribbons.

Term: CPT guidelines say that -sources refer to intracavitary placement or permanent interstitial placement; ribbons refer to temporary interstitial placement.-

-Simple- (77761) application uses one to four sources, -intermediate- uses five to 10, and -complex- uses more than 10, according to CPT. Medicare pays about $300, $400 and $600 respectively for the global brachytherapy services.

Intracavitary Radiation Source Application

Tip: You should be able to pick up the number of sources from the brachytherapy plan, says Ron DiGiaimo, MBA, president of oncology practice reimbursement firm Revenue Cycle Inc. in Austin, Texas.

If you can't find the number of sources in the documentation, you should speak with the physicist or physician who should be able to point out the documentation that supports a particular level quickly, DiGiaimo adds.

Stay Alert for 77761-77763 in These Cases

What it is: Intracavitary brachytherapy involves placing applicators with radioactive materials into or around a tumor-bearing area, according to CPT Assistant, Winter 1991. As the name -intracavitary- suggests, providers place the radioactive sources in body cavities including the lungs, esophagus and biliary system.

You may be most likely to see intracavitary radiation source application in gynecological cases, DiGiaimo says.

One common use of intracavitary brachytherapy is uterine (endometrium) or cervical carcinoma treatment.

Watch out: Anatomically, the cervix is part of the uterus, says coding consultant Melanie Witt, RN, CPC-OGS, MA, in her Coding Institute audioconference, -Tackle Tough Gynecological-Oncology Coding.- (Learn more at www.audioeducator.com.) But your ICD-9 choices vary depending on whether the patient has a cervical neoplasm (180.x, Malignant neoplasm of cervix uteri) or uterine body neoplasm (182.x, Malignant neoplasm of body of uterus).

Example: A patient diagnosed with a primary endometrial carcinoma receives intracavitary brachytherapy using 10 sources with applicators left in place for two days. You should report 182.0 (- corpus uteri, except isthmus) and 77762.

Remember: If the patient had a hysterectomy as part of the cancer treatment, you should still report 182.0 for treatment aimed at eradicating the uterine cancer. Why: As long as the physician directs treatment to the site, you should consider the malignancy to exist.

Official ICD-9-CM guidelines state: -When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10.x, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.-

Note: Oncologists sometimes order both brachytherapy and external beam radiation treatment (77401-77418) for a patient. In this case, you may report both services separately. One clinical treatment plan covers both therapies, so you should report only one of these professional treatment planning codes (77261-77263).

Bulletproof Your Documentation - Here's How

The physician's ideal procedure note should include the following, among other relevant information, DiGiaimo says:

       - rationale for using brachytherapy

       - intent (cure or palliative)

       - any devices used

       - an overall description of procedure events.