How to Code Weekly Clinical Management of Radiation Treatment
Published on Wed Sep 01, 1999
While the definition and counting of most radiological services or procedures assigned a CPT Code are relatively straightforward (e.g., a chest x-ray, angiogram, MR, or CT), the complexity of a course of radiation therapy requires development of a unique coding approach to describe and enumerate radiation oncology services.
Weekly clinical management is one of seven sections in the CPT-4 devoted to describing the services of radiation oncologists. The seven sections are consultation, treatment planning (772xx), physics (773xx), treatment delivery (77401 to 77417), weekly clinical management (77419 to 77499), hyperthermia (776xx), and brachytherapy (777xx). The weekly clinical management of radiation therapy to treat malignant neoplasms and certain non-malignant conditions is a highly technical and complex process that usually requires management of a course of treatment over an extended period of time. Combinations of codes from multiple sections of CPT Codes are often used to describe a course of radiation therapy.
Useful Terms Defined
It is important to clarify terms before reviewing the coding rules that apply to clinical weekly management.
Weekly clinical management is based on a weekly unit of treatment equal to five (5) fractions.
A fraction of a weekly unit is one session of radiation therapy.
Fractionalization is dividing the total treatment plan (or course of treatment) into the total number of sessions the patient will receive.
Hyperfractionation is defined as dividing the daily
dose into smaller doses that are given more than once a day.
Radiation is usually given once a day in a dose that is based on the type and location of the tumor. If the therapy plan calls for more than one treatment to be given per day to an area, treatments are usually separated by four to six hours. Studies of hyperfractionation are in progress to see if it is as effective or even more effective than therapy once a day. In certain tumors, the early results are encouraging. Some reports suggest that hyperfractionation therapy is becoming a more common way to provide radiation treatments.
8 Rules to Correctly Code Weekly Clinical Management
To confirm the coding rules that apply to weekly clinical management, we reviewed the American College
of Radiology (ACR) guidelines and consulted with
Linda Lively, MHA, president and CEO of American Medical Accounting and Consulting. Livelys firm has specialized in coding, training and auditing for radiation oncology practices for over 16 years. We also checked policies published by some local Medicare carriers. Of course, guidance in CPT was considered as well. [...]
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