Oncology & Hematology Coding Alert

Question: May I code two separate complex isodose plans for the same date of service if the plans are for separate anatomical sites?


Iowa Subscriber


Answer: If you have documentation of medical necessity and performance of the separate plans, you may code for both. Because both plans are the same level (complex), you may be able to report the plans with a two in the units field. For the complex plans, report 77315 (Teletherapy, isodose plan [whether hand or computer calculated]; complex [mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations]).

If you have plans with different complexity levels, you may need to append modifier 59 (Distinct procedural service) to the lower-level code.

Example: You have a report for a complex isodose plan and a simple plan. Report 77315 for the complex plan and then append 59 to the code for the simple plan, 77305 (- simple [one or two parallel opposed unmodified ports directed to a single area of interest]).

Caution: To charge for separate sites, the National Correct Coding Initiative says, you must verify that you-re coding noncontiguous sites (such as lung and prostate). Consider contiguous sites to be one site.