Radiology Coding Alert

Because clinical brachytherapy often offers significant advantages over radiation beam therapy, it's being used more frequently to treat a variety of forms of cancer. A complex process, brachytherapy must be coded based on each stage to ethically optimize reimbursement. There is no comprehensive code assigned for brachytherapy, explains 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. "Each component of the therapy is assigned its own code. Often, a coder will use seven or more codes to reflect the work involved." The multistep process typically involves a consultation with the patient, treatment planning, treatment simulation, dosimetry calculations and treatment management. Planning Vital to Treatment and Coding Radiation oncologists meet with patients who are candidates for brachytherapy, Parman says. "This is an intense and time-consuming meeting. The physician performs all the key components of an E/M service, taking a history, performing a physical examination, and considering various treatment options." Coders assign an office visit code to reflect this appointment. "In most cases, this is a level-five E/M service (e.g., 99205, New patient, office or other outpatient visit; CPT 99215 , Established patient, office or other outpatient visit; or 99245, Office consultation, new or established patient) because of the intensity of the history and examination elements and the complexity of the medical decision-making," she says. This E/M visit determines whether the patient will benefit from brachytherapy, Parman adds. "The next step involves highly detailed treatment planning, which includes interpretation of testing that had been done previously, localization of the area to be treated, and other procedures."

CPT Codes provides three codes to describe the professional treatment planning for clinical brachytherapy: CPT 77261 (Therapeutic radiology treatment planning; simple), 77262 ( intermediate) and 77263 ( complex). In most cases, Parman says, coders assign 77263 because of the complicated nature of brachytherapy planning. Note: A complete explanation of how to determine which level of treatment planning to report, "Unravel the Secrets of Radiation Treatment Planning," appeared on page 93 of the December 2001 Radiology Coding Alert. When coding interstitial brachytherapy for treatment planning with prostate cancer patients, coders may be able to report 76873 (Echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) in addition to the treatment planning code. In some facilities, the urologist instead of the radiation oncologist performs echography, and only the performing physician may bill the professional component of this service with a modifier -26 (Professional component). Simulation Reported Independently Simulation coding is determined by the complexity of the service. Four codes are available, each representing a higher level of simulation. When the simulation involves a single treatment area with either a single port or [...]