Oncology Coding Article – Coding Clarify Coding for Treatment Delivery

Specialty Groups — Oncology


Its nice to know that CMS can admit when they make a mistake, and the treatment delivery coding guidance issued as part of the OPPS update in January was more than a little confusing. In an attempt to clarify coding for treatment delivery, CMS now states: (more….)

Excerpt from Program Memorandum A-03-020, April 2, 2003:

VIII. Corrections to Transmittal A-02-129 issued on January 3, 2003:

A.Section XX. Billing for Radiation Therapy (CPT Codes 77401 through 77416). The instructions in Section XX of Transmittal A-02-129 were incorrect. Those instructions are revised to read as follows:

“CPT Codes 77401 through 77416 may be reported more than once per date of service only when radiation treatment is provided during completely different sessions. Only one of these codes may be reported for each treatment session no matter how many areas are treated or no matter how much radiation is delivered. CPT Codes 77402 through 77406 describe treatment delivery for a single treatment area. CPT Codes 77407 through 77411 describe treatment delivery to two treatment areas. CPT Codes 77412 through 77416 describe treatment delivery or three or more treatment areas. In the cases of CPT codes 77407 through 77416, the number of distinct treatment areas and complexity of the treatment determine which code series to report, which is then modified by the selection of energy (i.e., MV). For example, if three treatment areas are each treated with 11 MV, then the proper code to bill is 77414. It is incorrect to report 77404 – 77414 (for “11-19 MeV”) three times. However, if there is a distinct break and the same region of regions are treated again the same day then a second charge describing the energy and level of complexity is appropriate.”

Reprinted with permission from the Journal of Oncology Management

May/June issue

Cindy C. Parman, CPC, CPC-Hcparman-2775043
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.