Radiology Coding Alert

When treating a particularly difficult case of cancer with a multiservice regimen, the radiation oncologist may feel like Atlas, carrying the weight of the world and a lot of extra treatment management effort on his shoulders.

However, coders who know how and when to code CPT 77470 (Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) may help to lighten the burden. The special treatment code, 77470, is commonly reimbursed by payers but can easily be misused. "If you can document that special treatment planning was used, you should have no problem getting paid," says Carl Bogardus, MD, FACR, president of Cancer Care Network, a billing and coding consulting firm in Midwest City, Okla. Yet, the rules associated with the code lack clear direction, he says.

For example, with "ample documentation," 77470 can be used when treating anesthetized children with radiation therapy, because of the extra time and planning it takes to prepare a child, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga. Key to 77470 Is Lots of Extra Documented Work According to Medicare regulations, this code covers the additional physician effort and work required for the special procedures of hyperfractionation, total body irradiation, per oral or transvaginal cone use, or when other modalities are being managed in combination with external beam therapy, Lively says. These other modalities include brachytherapy, concurrent hyperthermia, planned combination with chemotherapy or other combined modality therapy, stereotactic radiosurgery, intraoperative radiation therapy, and any other special time-consuming treatment plan. IORT One of the indicated procedures in 77470, known as intraoperative radiation therapy (IORT), is not well-understood by coders. "IORT is designed to increase the intensity of radiation by delivering it directly to the tumor site during a surgical procedure," Lively says. Using radiation during surgery enables the surgeon to see and radiate the tumor through the open wound while protecting any normal tissues surrounding it.

Once the surgeon removes the tumor (partially or completely), IORT can treat any remaining microscopic disease within the surgical wound with high-energy medical linear accelerators, Lively says.

Although IORT was developed in the 1920s, certain insurers still consider this method of therapy to be investigational. The newest linear accelerators direct the radiation to a specific and well-defined body structure, thereby decreasing the risk of infection to open, anesthetized patients, Lively says, so make sure your payers understand the current technology.

Most patients are concurrently treated with high-dose external beam photon irradiation (77401-77416). Medical Necessity IORT has historically been used to deliver a boost dose of radiation to the tumor bed for selected early breast cancers (e.g., 174.x, Malignant neoplasm of female [...]