Unravel the Secrets of Radiation Treatment Planning
Published on Sat Dec 01, 2001
Radiation oncology practices may lose deserved revenue by inadvertently downcoding treatment planning services. Because they are not always sure what constitutes a complex treatment plan (77263, therapeutic radiology treatment planning; complex), coders may instead default to the code describing an intermediate plan (77262, intermediate).
Two strategies can help coders avoid this error, according to Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas: 1) ensuring that documentation is clear and thorough and 2) learning the discrete elements that comprise the various levels of treatment planning.
Documentation Vital to Assigning Code
CPT Codes recognizes radiation treatment planning as inherently complex and defines it as a process that includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other related procedures. "Coders should keep in mind that a treatment plan is a comprehensive service that addresses all aspects of patient care," notes Parman. Besides CPT 77262 and CPT 77263 , a code describing a simple plan (77261) is available.
Because the treatment plan encompasses many activities, documentation is critical. Most coding experts recommend that radiation oncologists keep a central log to track the services that are part of the treatment plan. "In practices where documentation isn't centralized, it's difficult for the coder to identify the relevant components," Parman says. "If some items are overlooked, it's likely that a lower-level code would be selected." In fact, Parman adds, chart auditors expect the treatment plan to be a separate chart entry and not embedded elsewhere.
Treatment planning is usually reported once per course of radiation therapy, even when multiple treatment modalities are delivered to the same anatomical site. However, Parman says, if unanticipated problems arise that necessitate a new course of treatment or treatment to a different anatomical site, a second treatment plan may be reported. "It is vital that the reason for the additional plan be clearly documented," she adds.
Distinguishing Between Levels
According to Lynn C. Esposito, CPC, clinical practice specialist with Hunter Radiation Therapy at the Yale University School of Medicine, coders may refer to a number of guides and handbooks to help them assign correct codes. "Most understand when treatment planning is considered simple," she says, "but it helps to have a reference on hand when distinguishing between the intermediate and complex levels."
One she recommends is published by the Cancer Care Network and includes a checklist of factors that correspond to simple, intermediate and complex plans. "We use this as our 'cheat sheet' to make sure we're coding correctly," Esposito says. This approach advises coders to take [...]
