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CODING CORNER: Simplify Brachytherapy Coding

Three Steps Make Reporting a Complicated Service Easy
Clinical brachytherapy is a complex procedure with no comprehensive code which means coding it is no walk in the park. But following these three steps simulation, isodose planning, and treatment will have you harvesting correct reimbursement as efficiently as doctors plant seeds.
Brachytherapy is intensive, localized radiation treatment designed primarily for several types of cancer. Since it's extremely effective, oncologists use it as either an alternative or a complement to external beam therapy. The doctor has two options to administer treatment: either insert small seeds filled with radioactive drugs interstitially as permanent implants or insert a catheter, pack it with medication, and remove it when the patient completes his course of treatment. Because of wide variation in cancers, the type, number, and radioactive intensity of the implants create a heap of details to sort through for correct coding but approaching the process piecemeal will lighten your load.
Measure Your Resources: Simulation
Once they've got the background info they need, radiation oncologists often simulate the administration of therapy to ensure they direct the nuclear material only to diseased tissue. You will usually use code 77290 (Therapeutic radiology simulation-aided field setting; complex), because brachytherapy is a complicated procedure, but as always, make sure your coding matches the appropriate amount of resources used. Keep in mind that "it is not always necessary to perform a simulation for brachytherapy services, so only those services documented should be billed," say Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc. in Atlanta.
Numbers Count: Dosimetry and Isodose Planning
In order to calculate the appropriate amount of radiation for the seeds, physics teams assist oncologists in preparation for therapy. Report this part of the service with these three codes:

77326 Brachytherapy isodose plan; simple (calculation made from single plane, one to four sources/ribbon application, remote afterloading brachytherapy, one to eight sources)


77327 intermediate (multiplane dosage calculations, application involving five to ten sources/ribbons, remote afterloading brachytherapy, nine to twelve sources)


77328 complex (mul-tiplane isodose plan, volume implant calculations, over ten sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over twelve sources).

The complexity of treatment is reflected by the specific number of sources, says Beverly Accordino, CCS, coder at the Inter-Community Campus of Citrus Valley Medical Center in Covina, Calif., so your codes should correspond to the level documented by the physician. "If it's not documented, though, just code 'simple,'" Accordino says.
Remember Associated Services: Treatment
For most brachytherapy treatments, you need to report the codes for seed placement, radiation [...]

- Published on 2003-05-01