Radiology Coding Alert

Experts show how to select consult, isodose and treatment planning codes

The next time your radiation oncologist plans a prostate brachytherapy implant, make sure you know how to report the physician's services - or risk denials for these costly procedures.

Radiation oncologists may use either low-dose brachytherapy (CPT 77778 , Interstitial radiation source application; complex) or high-dose brachytherapy ( 77784 , Remote afterloading high-intensity brachytherapy; over 12 source positions or catheters) to treat prostate cancer (185, Malignant neoplasm of prostate). The physician's consultations, isodose and clinical treatment planning can be even more difficult to report than coding the actual seed implantation, but a few simple tips can help you navigate these procedure codes. 1. Don't Overlook Brachytherapy Consultations Radiation oncologists often perform consultations at the request of other physicians, such as urologists or oncologists, usually regarding whether the patient is a good candidate for radiation therapy. Brachytherapy always requires a complete evaluation to determine whether the procedure is appropriate. During the evaluation, the radiation oncologist determines the best treatment regimen for the patient, which may include external beam irradiation followed by brachytherapy or brachytherapy alone. Only a radiation oncologist can make this determination, based on various factors such as the tumor size and location, and the patient's age or overall health status.

You should report a consult (99241-99245) or new patient visit (99201-99205) based on the radiation oncologist's E/M documentation. The level of decision-making normally drives the code choice, as long as the physician documents all required elements, says Deborah Churchill, RTT, owner of Churchill Consulting Inc., a consulting firm in Killingworth, Conn. "The risk will always be high. The level of decision-making will depend on the number of treatment options the physician considers and will usually be moderate (99244) or extensive (99245)."

The number of studies that the physician reviews or orders is another consideration in choosing the consultation level, Churchill says. "Because only two of the three elements must be achieved (risk, number of treatment options, number of studies ordered or reviewed), the level of the consult will be determined by the physician's documentation." 2. Choose 77263 for Clinical Treatment Planning Following the radiation oncologist's consultation, the physician will plan the brachytherapy treatment process. The planning process generally includes interpreting special tests and prostate localization procedures.

For the physician's clinical treatment planning, report 77263 (Therapeutic radiology treatment planning; complex), because insurers generally define brachytherapy alone or in combination with other treatment modalities as a complex planning service. As with any other service, medical record documentation must support the level of clinical treatment planning that you report. Procedures Include Physician Management You should not report physician management codes for brachytherapy procedures, because the procedure codes (77776-77778 and 77781-77784) already include those services, unless the individual [...]