Radiology Coding Alert

Take the mystery out of coding initial encounter and treatment planning When your radiation oncologist evaluates a patient for possible prostate brachytherapy, determine whether the encounter was a consult or an office visit and report the treatment planning with CPT 77263 - just be sure the planning service shows a high level of complexity. Choose High-Level E/M for Evaluation Radiation oncology offices usually encounter prostate brachytherapy patients in two ways: in the course of an evaluation and management service or during a consultation, typically at the request of a urologist, says Sandy McMaster, outpatient oncology financial specialist at Edward Cancer & Radiation Centers in Lisle, Ill.
 
During these initial visits, the radiation oncologist generally documents and reports a level-four or level-
five service. The first encounter with a brachytherapy candidate is very involved because the physician must be careful to rule out other treatment modalities (such as external beam treatments) before settling on brachytherapy, McMaster says.
 
Example: The radiation oncologist sees Patient X, who has prostate cancer and may benefit from prostate brachytherapy. The oncologist spends 35 minutes taking a history, performing a physical examination, and considering various treatment options - then calls Patient X's family into the room and counsels them for 20 more minutes. Documentation qualifies this encounter as a level-five service.
 On this claim, you should report:
   CPT 99205 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family, when the encounter is a new patient office visit.
   99215 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family, when the encounter is an established patient office visit.
   99245 - Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's [...]