Determining how often to use these professional-only codes and what documentation supports a complex radiation treatment is tricky for many radiation oncology coders. The clinical treatment planning process is a comprehensive cognitive effort that the radiation oncologist performs for every patient, and it involves many distinct and critical steps. For example, your physician may develop tumor mapping, a strategic plan, and the treatment's intent, goal and task by the time he completes the prescription for the radiation therapy, says Susan L. Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Wisconsin. 1. Report One Planning Code Per Course You should report a clinical planning code once per treatment course. But if your radiation oncologist discovers a new area of disease, such as melanoma (172.x, Malignant melanoma of skin), while treating a patient for an unrelated throat neoplasm (149.x), he may develop a skin cancer treatment plan. In that case, you would report the appropriate clinical planning code, such as 77262 (Therapeutic radiology treatment planning; intermediate), even if you reported it for her throat cancer in the past, Turney says. This type of billing may warrant a hard-copy claim to your payer with a letter from the radiation oncologist that explains that your patient has another form of cancer, unrelated to the first. If Cancers Are Related, Bill Only Once Most payers' local medical review policies (LMRPs) dictate that you can report treatment planning only once per treatment course, so proceed with caution if you report them more than once, even if your patient has a secondary cancer, says David Davis, CPC, a coding and reimbursement specialist with Infinity Reimbursement and Research in Alpharetta, Ga.
Suppose, for example, that your patient has lung cancer (162.x) that metastasizes into secondary cancer, such as bone metastasis (198.5). Typically, your radiation oncologist would incorporate the metastasis into the original planned radiation therapy, so you would report only the original planning code, Davis says. Because the lung and bone cancers are related (metastases), you cannot report treatment planning more than once.
2. Look in Documentation for Simple or Complex Blocking Make sure your radiation oncologist documents each aspect of clinical planning and tumor mapping. For instance, your physician should include the following in his or her documentation, says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.: whether the treatment will require simple or complex blocking
what methods your physician plans to use to localize [...]