Oncology & Hematology Coding Alert

Here's how to report 77261-77263 and get paid If you're not sure how to report 77261-77263 for clinical treatment planning, you're not alone. Radiation oncology coders say they're often unsure about how often they should use these codes and what documentation supports a complex radiation treatment. Follow four basic clinical treatment coding guidelines and improve your reimbursement for these services, coding experts say. 
 
Radiation oncologists use clinical treatment planning to determine how a patient will be treated. For example, your physician may develop tumor mapping, a strategic plan, and the treatment's intent, goal and task by the time he completes the prescription for the radiation therapy, says Susan L. Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Wisconsin. 1. Report One Planning Code Per Course Remember that you should report a clinical planning code once per treatment course. If your radiation oncologist discovers a new area of disease, say, melanoma (172.x, Malignant melanoma of skin), while treating a patient for throat neoplasm (149.x), your physician may develop a skin cancer treatment plan. In that case, you could report the appropriate clinical planning code, such as 77262 (Therapeutic radiology treatment planning; intermediate), Turney says.
 
But if you want to report additional treatment codes for the same patient, you should proceed with caution, says David Davis, CPC, a coding and reimbursement specialist with CEO Infinity Reimbursement and Research in Alpharetta, Ga. You should bill another code based on your physician's planning and documentation.
 
For instance, you should not use 77261-77263 if a patient with lung cancer (162.x) develops bone metastasis (198.5). Typically, your radiation oncologist would incorporate the metastasis into the planned radiation therapy, so you should report only one planning code, Davis says. 2. Look in Documentation for Simple or Complex Blocking Make sure your radiation oncologist documents each aspect of clinical planning and tumor mapping. For instance, your physician should include the following in his or her documentation, says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.:

  whether the treatment will require simple or complex blocking
  what methods your physician plans to use to localize tumor volume
  which special services, such as physics consultations, your radiation oncologist ordered
  the number and size of treatment posts
  which diagnostic tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) imaging scan, your radiation oncologist ordered
  consultations with physicians, such as surgeons. Also, include in the treatment plan your radiation oncologist's documentation regarding extra planning time and effort for special treatment procedures. For instance, your physician may cite intraoperative radiation therapy (IORT) (77470, Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]).
 
Radiation oncologists use IORT to [...]