Oncology & Hematology Coding Alert

Reporting 77300 multiple times in one claim can create confusion for the coder who doesnt know his or her carriers requirements. And although payment policies vary, if you follow this expert advice you will file your next simple dosimetry charge with ease.

Some carriers reimburse radiation oncologists each time they perform one of the eight dosimetric calculations: central axis depth dose, time dose factor, nominal standard dose, gap calculation, off-axis factor, tissue inhomogeneity factors, monitor unit calculation for electron field, and breast angle.

For example, if your radiation oncologist performs two dosimetry calculations on the same port while treating breast cancer (174.x), your carrier may allow you to bill 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off-axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) twice for the same treatment area, using the ICD-9 code of 174.x each time.

Learn How to Bill for Nine Calculations

Most carriers, however, pay only once per port, per treatment setup, says James E. Hugh III, MHA, vice president of AMAC, a consulting, coding and billing firm in Atlanta. Suppose your radiation oncologist treats a brain tumor patient (191.x) with nine ports of dosimetry calculations. You would report 77300 nine times, using the same diagnosis code of 191.x each time.

If the patient required further treatment after the tumors volume changed, for instance, and your oncologist treated with the same nine ports, you could bill for nine additional calculations, Hugh says.

But an exception would arise if your radiation oncologist performed dosimetry calculations with two ports on a patient with prostate cancer (185), for example, and the ports represented mirror images, such as anterior and posterior. In this case, you could report 77300 only once because the images are calculations of the same size, field, shape and depth.

As of July 1, the National Correct Coding Initiative, version 9.2, allows you to report 77300 and 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) on the same day of service. Suppose your radiation oncologist treats a patient for a five-field prostate cancer IMRT. The IMRT computer counts five dosimetry calculations. Later that day, your physics department verifies the calculations with separate specialized computer software.