Oncology & Hematology Coding Alert

Experts show you when to use 77778 and 77784

The next time your radiation oncologist performs prostate brachytherapy, make sure you know how to report the physician's consultations, treatment planning, simulations, and dosimetry calculations, coding experts say.
 
Radiation oncologists may use either low-dose brachytherapy (77778, Interstitial radiation source application; complex) or high-dose brachytherapy (77784, Remote afterloading high-intensity brachytherapy; over 12 source positions or catheters) to treat prostate cancer (185).

Don't Overlook Brachytherapy Consultations

Radiation oncologists usually spend a lot of time with a patient who has been referred for a consultation (99241-99245), says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC in Indianapolis. "This is the time a physician (oncologist) would spend with the patient prior to deciding whether or not to treat" a patient's cancer, he says. "This request for consultation ... would encompass elements outlined in medical or surgical E/M service codes." 
 
A consultation means that your radiation oncologist will provide an opinion or advice to another physician, such as a urologist. On the other hand, if the urologist sends the patient to your physician for evaluation and treatment, you must report new patient visit codes (99201-99205).
 
If your physician documents that he spent more than 50 percent of the office visit in face-to-face counseling or coordination of care with the prostate cancer patient, you consider time as the key element when you select the appropriate level of service, Hause says. For example, you may choose code 99245 (Office consultation for a new or established patient).

Choose 77263 to Report Treatment Planning

Following the radiation oncologist's consultation, the physician will probably plan the brachytherapy treatment process for the prostate cancer, Hause says. The planning process includes interpreting special tests and prostate localization.
 
To report the physician's brachytherapy planning, assign code 77263 (Therapeutic radiology treatment planning; complex), Hause says. But if the patient received a series of external beam treatments, and you billed for 77261, 77262 or 77263 and the physician included brachytherapy in the overall treatment plan, you should not charge for an additional service, coding experts say. Instead, you could report one complex service, such as 77263.
 
The radiation oncologist may also perform volume and mapping services, so the physician will know where to insert the catheter for the prostate seeds, says Craig McNabb, MBA, BSN, reimbursement manager for the Atlanta branch office of US Oncology. For this service, use 76873 (Echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]).
 
But make sure you don't report 76873 on the same day as a seed implantation code, such as 77778 (Interstitial radiation source application; complex), because the National Correct Coding Initiative bundles 77778 and 76873.

You Need 77290 for Simulation Procedures

When the physician wants to ensure that he or she delivers radiation only to the diseased tissue, you will need to turn to simulation codes to report those services. If the radiation oncologist conducts a simulation, such as a pubic arch study, you may list 77290 (Therapeutic radiology simulation-aided field setting; complex), says Deborah Churchill, president and founder of Churchill Consulting Inc., an auditing and electronic coding consulting firm in Killingworth, Conn.

Know the Brachytherapy Intensity  

If you want to choose the correct code for dosimetry and isodose planning, make sure you know the brachytherapy intensity.
 
Typically, a radiation oncologist needs to calculate radiation doses to ensure that the patient receives the appropriate amount of radiation. The oncologist will use an isodose plan to determine how much radiation he or she needs to treat the patient's tumor.
 
If the physician recommends complex brachytherapy treatment, for example, you should use code 77328 (Brachytherapy isodose plan; complex [multiplane isodose plan, volume implant calculations, over 10 sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over 12 sources]), McNabb says.
 
You should never report 77327-77328 multiple times on a single day for the same physician, because the NCCI bundles the codes. Therefore, you should also avoid attaching modifier -76 (Repeat procedure by same physician) to 77326-77328.
 
When your radiation oncologist performs computer-generated, 3-D reconstruction during treatment planning, you may assign 77295 (Therapeutic radiology simulation-aided field setting; three-dimensional). The NCCI bundles 77295 with simulation codes 77280-77290.

Bill 77370 for Physics Consult

If your physician consults with a physicist during complex dosimetric services, report 77370 (Special medical radiation physics consultation).
 
The oncologist may also perform a series of independent calculations to ensure that the complex computer-aided isodose plans and the treatment duration are proportional to the source quantity and activity. In that case, use 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician).
 
Report each basic dosimetry calculation (77300) during prostate brachytherapy treatment, coding experts point out.