Oncology & Hematology Coding Alert

Knowing simple vs. complex brings an $80 reward. Radiation treatment planning is complex work " so you might be tempted to turn to 77263 every time. But you've got to be sure your documentation makes the grade first, or you could risk upcoding accusations. Start with the basics: After the radiation oncologist decides radiation therapy is appropriate for the patient, the oncologist must embark on the "comprehensive and often intense undertaking" of determining the course of treatment, according to AMA's CPT Assistant (October 1997). Treatment planning allows the oncologist to determine how best to deliver radiation to the tumor while protecting healthy tissue. The appropriate codes for planning the treatment course are the following: • 77261 -- Therapeutic radiology treatment planning; simple • 77262 -- ... intermediate • 77263 -- ... complex. These codes are "professional component only" codes, meaning you should not append a modifier 26 (Professional component) or TC (Technical component) [...]