Radiology Coding Alert
Unravel the Secrets of Radiation Treatment Planning
Two strategies can help coders avoid this error, according to 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: 1) ensuring that documentation is clear and thorough and 2) learning the discrete elements that comprise the various levels of treatment planning.
Documentation Vital to Assigning Code
CPT Codes recognizes radiation treatment planning as inherently complex and defines it as a process that includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other related procedures. "Coders should keep in mind that a treatment plan is a comprehensive service that addresses all aspects of patient care," notes Parman. Besides CPT 77262 and CPT 77263 , a code describing a simple plan (77261) is available.
Because the treatment plan encompasses many activities, documentation is critical. Most coding experts recommend that radiation oncologists keep a central log to track the services that are part of the treatment plan. "In practices where documentation isn't centralized, it's difficult for the coder to identify the relevant components," Parman says. "If some items are overlooked, it's likely that a lower-level code would be selected." In fact, Parman adds, chart auditors expect the treatment plan to be a separate chart entry and not embedded elsewhere.
Treatment planning is usually reported once per course of radiation therapy, even when multiple treatment modalities are delivered to the same anatomical site. However, Parman says, if unanticipated problems arise that necessitate a new course of treatment or treatment to a different anatomical site, a second treatment plan may be reported. "It is vital that the reason for the additional plan be clearly documented," she adds.
Distinguishing Between Levels
According to Lynn C. Esposito, CPC, clinical practice specialist with Hunter Radiation Therapy at the Yale University School of Medicine, coders may refer to a number of guides and handbooks to help them assign correct codes. "Most understand when treatment planning is considered simple," she says, "but it helps to have a reference on hand when distinguishing between the intermediate and complex levels."
One she recommends is published by the Cancer Care Network and includes a checklist of factors that correspond to simple, intermediate and complex plans. "We use this as our 'cheat sheet' to make sure we're coding correctly," Esposito says. This approach advises coders to take a top-down approach to scoring the treatment plan by initially looking for any elements that fall into the "complex" category. If any are found, 77263 may be assigned. If not, coders should look at possible intermediate factors, assigning 77262 if they are identified. If factors from neither category are documented, the simple code (77261) must be used.
Among the factors the Cancer Care Network lists in the complex category are the use of intensity-modulated radiation therapy (IMRT), whether three or more areas or volumes are planned, and whether moving portals such as rotation or arc are planned. Similarly, the list of intermediate factors includes two separate areas or volumes planned, custom blocking and the use of simple immobilization devices. Simple treatment planning includes a single area or volume planned, simple or no blocking, and a single central axis dose point.
Esposito adds that Parman's company, CSI, also publishes a highly practical guide in its Coding Guide for Radiation Oncology. "It's been extremely valuable for our coders," she notes.
Simple Treatment Planning
Parman recommends that 77261 be assigned when treatment planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports, with simple or no blocking. In addition, it can be used when:
Intermediate Treatment Planning
When documentation includes planning that requires three or more converging ports, two separate areas, multiple blocks, or special time or dose constraints, coders should report 77262. Other factors to be considered are:
Complex Treatment Planning
Parman says complex treatment planning requires highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotational or special beam considerations and a combination of therapeutic modalities. These may include:
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