Your Radiation Oncology Coder Needs to Decide: Simple, Intermediate, or Complex?
Radiation therapy can be delivered using several different modalities, either alone or in combination. Common modalities include external beam, brachytherapy and hyperthermia. Generally, the more modalities combined in treatment, the more complicated the treatment plan. The typical course of radiation therapy will consist of one treatment plan. If a completely new area of disease requires treatment and a new treatment course, then a second treatment plan may be necessary, but only one clinical treatment planning service is billable per course of treatment. Clinical treatment planning codes (CPT codes 77261 (Simple), 77262 (Intermediate), or 77263 (Complex)) are the professional charges for the physician to integrate the patient's overall medical condition and extent of disease, and to formulate a plan of therapy for the patient.
Clinical treatment planning is a separate and discrete step in the process of care that represents services that are unique and distinct from those provided within other planning codes. Within clinical treatment planning, the radiation oncologist develops the specific parameters of the therapeutic management plan, including the overall clinical, physical and technical aspects of radiation treatment required for safe and effective therapy for each patient. This includes determining the treatment modality, total dose, fractionation, and the need for planned field changes. The physician must select from the various radiation modalities (e.g., IMRT, 3-D conformal, brachytherapy, etc.), and decide whether to combine chemotherapy with radiation therapy. The treatment plan that emerges from this step will include the types of radiation that will be utilized, areas to be treated, techniques for treatment, doses to be delivered and the duration of therapy. A clinical treatment planning code may be reported regardless of which modality is ultimately chosen to treat the patient.
What are the Physician Fee Schedules for Simple Intermediate and Complex?
|
Code |
Description |
Medicare Fee Schedule |
|
77261, Simple |
This code is used when the volume of interest to be treated is clearly defined and easily encompasses the tumor while excluding normal tissue and structures. Simple planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking. |
$77.52 |
|
77262, Intermediate |
This code is used when there is a moderate level of planning difficulty involved. It requires one of the following: three (3) or more converging ports, two (2) separate treatment areas, multiple pre-made or manufactured generic treatment devices or blocks, or special time dose constraints. |
$115.20 |
|
77263, Complex |
Complex planning requires one of the following: highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three (3) or more separate treatment areas, rotational or special beam considerations, or combination of therapeutic modalities. Complex planning 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 procedures. |
$169.04 |
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