Oncology & Hematology Coding Alert

Keep a careful eye on how often you report 20-MeV codes (77406, 77411 and 77416) if you bill the codes significantly more often than you report the other radiation treatment delivery codes, you might be erroneously adding together energies from separate treatment areas.
 
According to CMS' physician utilization data, radiation oncology coders reported the "20-MeV" codes (77406, 77411 and 77416) less frequently than they reported the lower-energy codes in each category. Several factors affect which codes you ultimately report, such as your oncologist's patient base, sub-specialty and geographic region.
 
To determine whether you report radiation treatment delivery services more or less frequently than other radiation oncologists do, you should "benchmark" your code use against CMS national averages, many coding consultants say.
 
The following chart demonstrates how many radiation oncology claims CMS processed in 2001 (the most recent year for which data are available).
 
Source for raw data: "1997-2001 Procedure Code Utilization by Specialty," available on the CMS Web site at www.cms.gov/physicians/pfs.