Oncology & Hematology Coding Alert

Question: I have a report from a radiation oncologist planning treatment for a patient who received a kidney transplant in the past. The report documents extra work to protect the vessels leading to the kidney. The radiation therapy is concurrent with chemotherapy. Can I report 77470? If so, how many times should I report it?


Alabama Subscriber


Answer: Because you've got the proper documentation, you should report 77470 (Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) - but only report it once.

Apply 77470 for documented planning and effort involved in performing the special procedure. Although you have listed two separate issues requiring special procedures - protecting systems related to the transplanted kidney and radiation concurrent with chemo - payers, including Cigna, Palmetto, and Blue Cross and Blue Shield of Alabama, typically tell you to report 77470 once per course of treatment.

Good news: You may report 77470 in addition to treatment planning, which will usually merit 77263 (Therapeutic radiology treatment planning; complex). In Alabama, this will bring an extra $480, so remind your doctor to document the additional time and effort required for the procedure to support using this code.

When to code: In addition to the examples given in the descriptor and your example, you may also be able to report 77470 if your physician documents hyperfractions, particularly complicated brachytherapy, hyperthermia, concurrent treatment of multiple sites, retreatment of a site, or proton therapy.

When not to code: Typically, you shouldn't report 77470 for hormone therapy, 3-D simulations or when radiation therapy follows chemo or chemo follows radiation. And unless an ongoing problem such as diabetes or hypertension affects the planning and requires special procedures, don't report 77470 just because you have documentation of these diagnoses.