Oncology & Hematology Coding Alert

Because clinical brachytherapy often offers significant advantages over radiation beam therapy, it's being used more frequently to treat a variety of cancers. A complex process, brachytherapy demands careful coding to ensure that each stage is reported properly. There is no comprehensive brachytherapy code, says Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports more than 1,350 physicians from various specialties. "Each component of the therapy is assigned its own code. Often, a coder will use seven or more codes to reflect the work involved." The multistep process typically involves: consultation with the patient treatment planning treatment simulation dosimetry calculations treatment management. Step 1: Assessing the Patient Radiation oncologists meet with candidates for brachytherapy, Parman says. "This is an intense and time-consuming encounter," she says. "The physician performs all the key components of an E/M service, taking a history, performing a physical examination and considering treatment options." Assign an office visit code for this appointment. "In most cases, it will be a level-five E/M service (i.e., 99205, New patient, office or other outpatient visit; 99215, Established patient, office or other outpatient visit; or 99245, Office consultation, new or established patient), because of the intensity of the history and examination elements, and the complexity of the medical decision-making," she says. Step 2:Planning Is Vital to Treatment If the oncologist determines the patient will benefit from brachytherapy, detailed treatment planning comes next, Parman says: "This includes interpretation of earlier testing, localization of the treatment area, and other procedures." CPT provides three codes to describe the professional treatment planning for clinical brachytherapy: 77261 (Therapeutic radiology treatment planning; simple), 77262 ( intermediate) and 77263 ( complex). In most cases, Parman says, coders should assign 77263 because of the complicated nature of brachytherapy planning. Coders might be able to report CPT 76873 (Echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) in addition to treatment planning when they code interstitial brachytherapy with prostate cancer patients. The study allows the oncologist to visualize the prostate and determine its position so he can optimize subsequent radioactive seed placement. A coder should report only the professional component of this service with a -26 modifier (Professional component) when this service is performed in the hospital. Note: In some facilities, the urologist performs this service and should report it. Step 3:Simulation Is Reported Independently "[Treatment simulation] is an important step because the physician must assure that the therapy is delivered only to the diseased tissue and does not damage tissue unaffected by the cancer," Parman says. Simulation coding is determined by the complexity of the service. Four codes are available, each representing a higher level of simulation. 77280 (Therapeutic radiology simulation-aided field setting; simple) [...]