Oncology & Hematology Coding Alert

Question: Can I bill office and outpatient evaluation and management (E/M) codes 99202-99205 and radiation oncology clinical management codes 77261-77263 together on the same date of service (DOS) for a newly diagnosed cancer patient seeing the same provider for both services? If yes, do I need a modifier and, if so, which one?

AAPC Forum Participant

Answer: The therapeutic radiation treatment planning codes 77261 (Therapeutic radiology treatment planning; simple), 77262 (… intermediate), and 77263 (… complex) are intended to prepare a patient for radiology. They describe a service where a provider decides the location and the number of ports for the radiation to enter the body, the design and location of the shielding blocks, and the mode, or modes, of radiation therapy.

Under certain circumstances, it is possible to bill a therapeutic radiation treatment planning code with an office/outpatient E/M from 99202-99205 (Office or other outpatient visit for the evaluation and management of a new patient …), which is especially helpful if the provider first performs a consult for a new Medicare patient.

Here’s why: As Medicare does not recognize consult codes, you could use the new patient office/outpatient E/M for the consult and the appropriate service from 77261-77263 for the clinical treatment planning, Under those circumstance, you would then append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M to indicate it was a significant and separately identifiable service as long as the documentation supports the modifier assignment on the E/M code.