Oncology & Hematology Coding Alert

Question: Can I code 77470 when performing a computerized tomography (CT) scan and 3 D simulation, 77295 ? Does this qualify for any other time- consuming plan? Also, what documentation is necessary?

New York Subscriber

Answer: Deciding which radiation oncology services to include in the special procedures category may vary from one payer to another. However, they generally require the technical component for the CT scan be coded using 76370 (computerized tomography for placement of radiation therapy fields), and that the work required to create the 3-D plan be reimbursed using 77295 (three-dimensional simulation). Most payers do not consider the creation of a 3-D plan to warrant 77470 (special treatment procedure [eg. total body irradiation, hemibody radiation, per oral, endocavity or intraoperative cone irradiation) to indicate a special procedure. In fact, the performance of a 3-D plan is becoming routine in many practices.

Code 77470 is assigned whenever there is an especially time-consuming treatment procedure. It is also used when extra planning and effort are not identified by specific codes and are required to ensure an optimum radiation therapy course of treatment. The CPT manual lists the following regimens that qualify for 77470:

Total body irradiation (TBI);

Hemibody radiation (HBI), per oral, endocavitary or intraoperative cone irradiation.

In addition, the following regimens and procedures are considered for payment by many insurers: proton therapy, hyperfractionation, certain brachytherapy procedures such as prostate seeds, stereotactic radiosurgery, intensity modulated radiation therapy (IMRT), retreatment of the same site, concurrent multiple site treatment, treating a site abutting a previously treated site, and concurrent chemotherapy.

Each of the above has an element of physician and facility work that is not accurately defined by a specific code, and which may meet individual payer guidelines for the assignment of 77470. Remember, though, that it is not intended for use when the patient has another ongoing medical condition such as diabetes hypertension and chronic obstructive pulmonary disease, (COPD) because the code is intended for use in radiation treatment not to account for additional care as a result of other conditions.

Documentation for assignment of the special procedure code can take many forms. In some cases, the radiation oncologist dictates the qualifier into the initial consultation report, such as when the patient is receiving concomitant chemotherapy. In other cases, the nature of the service performed, such as stereotactic radiosurgery, will drive the assignment of 77470. If your organization has a policy surrounding the use of this code, it may include situations when it is to be assigned and the specific area of the chart where supporting documentation will be maintained.