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Radiology Coding Alert

Avoid Common Mistakes When Reporting Special Services Codes

If your radiation oncology practice frequently reports special services codes 77321, 77331 and 77470 keep in mind that these codes are called "special" for a reason. You must maintain pristine documentation and follow strict carrier guidelines, because payers' policies for these services vary widely.
Report CPT 77321 Once Per Course
  77321 Special teletherapy port plan, particles, hemibody, total body. "This service doesn't exactly require 'special' work," says Deborah I. Churchill, RTT, president of Churchill Consulting Inc., a Killingworth, Conn.-based consulting firm that offers audits, seminars and electronic coding applications. "Rather, you should report this code when you use electrons as part or all of the treatment regimen."

You should report 77321 once per course of treatment. In addition, if the radiation oncologist performs a monitor unit calculation to treat the patient, he or she should also report CPT 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the teaching physician) once per each electron portal treated. If you perform a calculation only, you should simply report 77300 and not 77321.
Although some practices report 77321 for every patient who receives electrons, you should note that some payers will not reimburse for this special service when the treatment consists of "routine" electron fields used for ribs or simple skin lesions, electron boosts for breast cancer or the treatment of lymph nodes.
According to First Coast Service Options' (a Florida carrier) local medical review policy (LMRP), special teletherapy port plans are medically necessary "only when a plan for a special beam consideration is required for the treatment of a neoplasm, such as the use of electrons or heavy particles."

Use Caution When Reporting Isodose Plans
Depending on your carrier's guidelines, you may be able to report 77321 on the same date as an isodose plan (77305-77315), although there are payers that will deny 77321 when reported with these codes, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, RMC, billing supervisor at Oncology Hematology West P.C. Carriers' policies not only differ widely they can also contradict themselves.
The LMRP for Iowa's Part B carrier (Noridian Medicare) states, "The National Correct Coding Initiative bundles 77305, 77310 and 77315 into 77321 and so it will not allow payment for a combination of these codes unless 77321 is for a different volume of interest other than one or the other codes." But the same LMRP also states, "If special teletherapy port plan is used, CPT codes 77305, 77310 and 77315 are not to be billed."
Append -59 to Report Isodose Plan
Because of the confusion surrounding this issue, you should [...]

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