Radiology Coding Alert

The American Medical Associations CPT 2000, released last month, contains several important changes that will affect the radiology coder.

Radiation oncology is probably the area impacted most significantly, according to Linda Lively, MHA, president and CEO of American Medical Accounting and Consulting in Marietta, GA. The sheer number of changes in radiation oncology is not that great, she says, but they will have a tremendous impact on how we assign codes to our most common activities.

Specifically, the CPT 2000 has replaced four codes previously assigned for weekly management of radiation therapy with a single code. The new code is CPT 77427 (radiation treatment management, five treatments), Lively says. It replaces 77419 (weekly radiation therapy management; conformal), 77420 (simple), 77425 (intermediate) and 77430 (complex).

The benefit of this change, she says, is that it will simplify the billing processcoding professionals have only one choice. But the downside is that most radiation oncologists will experience a reduction in reimbursement.

The new RVU (relative value unit) for the 77427 code is 3.31, which is higher than the RVU for simple radiation treatment management in the past. However, it is lower than the previous RVU for complex management, which was in the 3.5 or 3.6 range. And I would estimate that 80 to 90 percent of a radiation oncologists work would be considered complex. Im sure the AMA figured that it would all even out, but Im not convinced that will be the case.

Lively expects that this replacement code may cause some confusion early next year, as well. Medicare will begin using 77427 as of Jan. 1, 2000, she points out, but other insurers will be scrambling to make the change. In the interim, radiology coders will need to use the new code for some payers and the old codes for others.

Another important new radiation oncology code is 76873 (prostate volume study for brachytherapy treatment planning), used for seed implantation in prostate cancer patients. In the past a variety of codes were used, says Lively, whose firm has specialized in coding, training and auditing for radiation oncology practices for more than 16 years. Some were urology codes and others were radiology codes. The new code will clarify things a great deal, since the language clearly describes prostate disease and brachytherapy. Its an important change because this treatment is very popular right now.

Lively also noted that the addition of two CPT Codes describing proton beam treatment delivery is significant. Not many radiation oncologists provide this treatment alternative because the equipment is large and expensive. Nevertheless, in the past these physicians had to assign 77499 (unlisted procedure, therapeutic radiology, clinical treatment management), which wasnt very desirable. This change will help a great [...]