Radiology Coding Alert

Clinical brachytherapy the transperineal implantation of permanent radioisotope seeds has become widely accepted as an effective treatment for prostate cancer. It is a highly time-intensive procedure, involving multiple steps, and requires radiation oncology coders to clearly understand proper coding strategies for each component to avoid claim denials.

We find that our physicians at a nearby cancer center are using seed implantation for about 50 percent of the cases they see, says Remo Peshkepia, director of client services for Healthcare Management Partners in Irvine, Calif., which provides billing and management support to four cancer centers and 11 radiation oncologists throughout the state. As a result, he notes, coding professionals must become familiar with the complex nature of the procedure to achieve appropriate reimbursement.

Briefly stated, brachytherapy is a treatment for prostate cancer in which radioactive seeds are delivered by a needle and permanently placed in the prostate gland. The seeds emit radiation that destroys one or both strands of DNA within the cancer cells so the tumor can no longer grow. The number of seeds and the dose of radiation are calculated precisely to be most effective against the cancer while preserving nearby healthy tissue.

Brachytherapy generally is used by itself when the tumor is encapsulated in the prostate and has not metastasized. It may be used in combination with the more traditional external beam radiation. Instances in which the combined modality treatment is used are determined by the pathological staging of the cancer.

Coding Each Step of Brachytherapy Treatments

When you are coding a radiation procedure like brachytherapy, you must keep in mind each of the distinct steps involved, advises Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. In most cases you will be able to assign about seven or more codes, which may include consultation, treatment planning, treatment simulation, dosimetry calculations and isodose planning, treatment management and, sometimes, additional special services.

Step 1: Consultation

According to Parman, radiation oncologists likely will spend a great deal of time when a patient has been referred for a consultation. This is the time a physician would spend with the patient prior to deciding whether or not to treat, she says. This consultation would encompass elements outlined in medical or surgical evaluation and management service codes. But because of the intensity of this visit, it would almost always be assigned the most extensive CPT Code , 99205 (new patient; office or other outpatient visit) or 99245 (office consultation for a new or established patient) because the [...]