Advanced Search

Oncology & Hematology Coding Alert

E/M With Brachytherapy? NCCI Says, 'Don't Even Think About It'

Published on Mon Oct 10, 2005

Your only options are observation, consultation and prolonged services

Give every brachytherapy claim with an E/M service a second glance before you send it in, because the National Correct Coding Initiative, version 11.3, effective Oct. 1, officially curbs your ability to report even more code pairs.

Example: The new edits tell you not to report 99239 (Hospital discharge day management; more than 30 minutes) with 77763 (Intracavitary radiation source application; complex). If you did report both, you-d only receive payment for 77763.

Good news: You-re unlikely to report the bundled pairs together, says Kristin Bentley, CPC, a radiation oncology coder for University of Minnesota Physicians. Along with hospital discharge, the edits limit your use of newborn (99298-99299, 99431-99440), nursing or rest home (99301-99333), and home (99341-99350) service codes. 

Bottom line: Double-check your claim to be sure you haven't reported one of these codes. The wrong E/M code will mean instant denial. Apply Same Edits to All Brachytherapy Now You won't be seeing as many bundles for 77776 (Interstitial radiation source application; simple). NCCI deleted a number of edits for this code. You now have the option to report consultations, physician standbys (which have no RVUs), and prolonged physician services with 77776. This brings 77776 into line with the edits for the other brachytherapy codes.

You-re unlikely to code a consult with 77776, Bentley says. The doctors and physicists need time to complete preplanning before delivering treatment.

-I can't imagine an urgent brachytherapy situation where you would consult, CT, plan and treat on the same day,- says Sandy McMaster, outpatient oncology financial specialist for Edward Hospital Cancer Center in Illinois.

The prolonged services bundles are unlikely to cause a stir because codes 99354-99355 are add-on codes for those rarely used consultation codes.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Oncology & Hematology Coding Alert

View All