Dont Let Special Handicap Your Payment:
Show Payers Dynamite Documentation
Published on Sun Jun 01, 2003
What's so special about your physician's work? If payers can't answer this question from your documentation, then you have no medical justification for claiming that your service is beyond routine and deserves payment because it is. The name of the game for getting these services paid is documentation that shows the services are indeed "special," says Cindy Parman, CPC, CPC-H, RCC, at Coding Strategies Inc. Special services for radiological oncologists have their unique requirements, but one thing's true for all of them: Avoid "cloned documentation" with a 10-foot pole.
The phenomenon of cloned notes is one of the most recent coding plagues infecting every medical specialty. Cloned notes those from day to day or from patient to patient may lead to denials and recoupments for overpayments, says Georgette Gustin, CPC, CCS-P, CHC, director of PricewaterhouseCoopers in Indianapolis. You don't want your physician's notes for one patient to look exactly like the notes for every other patient with that condition, she says. Documentation instead should be patient-specific, she says.
That means you should avoid large amounts of preprinted text on your physician's notes and circled templates, especially for services that are "special" or unique to the type of service, Parman adds. These four services raise the bar for medical necessity because you have to prove they're above and beyond the routine services of its type. Special Teletherapy: According to Parman, payment for 77321 (Special teletherapy port plan, particles, hemibody, total body) requires:
the direct involvement of the radiation oncologist
a statement in the medical report that says it is part of the isodose plan
that you do not automatically bill it, and only in certain circumstances do you report 77321 as a basic calculation. Special Dosimetry: You must establish medical necessity when you report 77331 (Special dosimetry [e.g., TLD, microdosimetry] [specify], only when prescribed by the treating physician). Medical necessity for this service requires:
a written request by the radiation oncologist
the presence of hermoluminescent dosimetry, microdosimetry, film dosimetry, solid-state diode, or other methods of measuring specific dosage
documentation for the special radiation measuring and monitoring devices used, such as solid-state diode probes
hard-copy documentation of the measurements with additional notes regarding the measuring devices used, which the physicist and radiation oncologist must sign
results that serve to accept or modify the current treatment plan, Parman says. Add to this last requirement these two qualifications: The physician doesn't routinely use 77331 for a patient under treatment and doesn't request 77331 as a quality-assurance measure, she says. Reporting this service should be reserved for complex clinical treatment planning in which the physician measures the amount of radiation a patient has received. Reporting special dosimetry is [...]
