Complex 3-D Treatment Planning May Challenge Coders
Published on Mon Nov 01, 1999
Three-dimensional (3-D) tumor simulation treatment planning for cancer patients is a complicated and time-consuming process for radiation oncology practices. Coding professionals must clearly understand the discreet steps and assign the appropriate codes that accurately reflect the work involved.
The concept behind 3-D radiation simulation treatment planning is relatively simple. Before a cancer patient actually receives radiation therapy, 3-D images are used to determine the proper dosage and most effective distribution of the treatment. Creating the plan is a demanding process, however, with multiple steps and complicated requirements.
The American Medical Accounting and Consulting firm (AMAC), based in Marietta, GA, has devised a typical scenario for 3-D radiation simulation treatment planning that outlines each step and coding considerations that will affect how radiation oncology practices may charge for each. AMAC Vice President James E. Hugh, MHA, points out that becoming as familiar as possible with 3-D treatment planning codes is advantageous to a billing professional because reimbursement rates are much higher than traditional radiation treatment planning.
The scenario devised by AMAC, which has specialized in coding, training and auditing radiation oncology practices for more than 17 years, can be used in two circumstances: during the initial set-up for radiation therapy or at boost time. Usually, a patient undergoes initial radiation therapy for a prescribed amount of time, Hugh explains. Then, after the tumor has shrunk or other factors come into play, there will be another boost or cone-down. At that time, another plan is devised for the boost or cone-down.
He points out, however, that the 3-D simulation treatment plan should be used only once during the course of a patients therapy. If you have billed the initial set-up as a 3-D radiation simulation treatment plan, you should bill the boost with conventional radiation oncology planning and simulation coding methods, Hugh says. On the other hand, some radiation oncologists will begin treatment without a 3-D plan. Under these circumstances, the patient could receive 3-D simulation treatment planning at boost time.
Hugh adds that the 3-D radiation simulation treatment plan can be noncoplanar or coplanar.
Common Charging Scenario for 3-D Radiation Simulation Treatment Planning
Monday: The patient is simulated by being placed into a precise treatment position. An immobilization devicelike a vac-lock or alpha-cradleis created while the patient holds that position. When the radiation field is determined, the patient is tattooed to ensure accurate delivery of radiation.
Coding: Depending on the complexity of the process, one of the following codes would be assigned:
CPT 77280 therapeutic radiology simulation-aided field setting; simple
CPT 77285 therapeutic radiology simulation-aided field setting; intermediate
77290therapeutic radiology simulation-aided field setting; complex
In addition, CPT code 77334 would be assigned for the immobilization device (complex, [irregular blocks, [...]
