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Radiology Coding Alert

Benchmark Your Radiation Code Use

Published on Thu May 01, 2003

According to CMS' physician utilization data, radiation oncologists reported the "20-MeV" codes (CPT 77406 , 77411 and 77416) less frequently than they reported the lower-energy codes in each category. Although several factors (such as your patient base, sub-specialty, geographic region, etc.) affect which codes you ultimately report, if you bill the 20-MeV codes significantly more than you report the other radiation treatment delivery codes, you might be erroneously adding together energies from separate treatment areas.

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.  
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