Radiology Coding Alert

A weekly physics review chart will keep you in your payer's good graces

Misunderstanding even one word in the descriptors for radiation oncology codes 77321 and 77336 could land you in hot water. Read on to see what "special" and "week" really mean.

Question: You mentioned radiation oncology codes 77321 and 77336 in last month's issue, because the latest National Correct Coding Initiative edits say not to report those codes with G0173 (Linear accelerator based stereotactic radiosurgery ...). When should I report 77321 and 77336?

Answer: Making sure you have the documentation to support reporting these codes is crucial. Here's what you need to be on the alert for.

77321: Before you report 77321 (Special teletherapy port plan, particles, hemibody, total body), check that the documentation indicates that the radiation oncologist directly participated in ordering, calibrating, and providing any other services required for the special teletherapy port plan. Your documentation should also supply proof of medical necessity.

Heads up: You need a printed plan signed by the physician and physicist to satisfy most payers' requirements, says radiology and oncology coding expert Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.

Red flag: The word "special" means you need to have the right circumstances before you can report the code.
 
Don't fall prey to the common mistake of reporting this code automatically for electron services, Parman says.

77336: The radiation oncologist orders the procedure described by 77336 (Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy), but a physicist (or dosimetrist under physicist supervision) performs it.

Watch for: In a hospital setting, you should not report this technical-only code for your physician group--the facility claims it. If you work for a freestanding center and have thorough documentation from the physicist that he reviewed and made recommendations for all aspects of the patient's care, you may report this code. 

Many payers cover this code--which states "reported per week of therapy"--once for every five therapy fractions, so be sure you know your payer's definition of "week." 

Tip: You must have a documented physics review during each five-fraction week of therapy to support this code. Try this: Create a weekly physics review chart document for the physicist to check off his completion of all aspects of the protocol.