Radiation oncology, as the branch of medicine concerned with the use of ionizing radiation in the treatment of cancer, and certain non-malignant medical conditions, is comprised of several layers of care and treatment modalities that are highly complex in nature. Coding for radiation oncology requires a unique set of skills and abilities that are specific to this highly technical and multi-faceted clinical specialty. Certified radiation oncology coding specialists are adept at navigating the subtleties and distinctions that define this field of concentration including the various procedures that comprise treatment delivery.
Radiation oncology procedures:
- High Dose Rate (HDR) Brachytherapy
- Image-Guided Radiation Therapy (IGRT)
- Intensity-Modulated Radiation Therapy (IMRT)
- 3D Conformal Treatment
- 4D Treatment Planning and Respiratory Gating
- Electron Beam Treatment
- Stereotactic Radiosurgery (SRS)
- Stereotactic Body Radiation Therapy (SBRT)
- Volumetric Modulated Arc Therapy (VMAT)
Radiation oncology coding specialists have the ability to read and condense physician office and procedural notes to appropriately summarize the consultation, or procedure, and create an effective synopsis.
- Expertise in correctly interpreting physician documentation and summarizing the information provided regarding office consultations, and other outpatient consultations, and their relevance in the treatment process.
- Working knowledge of treatment preparation and planning services; recognizing simple, intermediate, and complex levels of preparation.
- Experienced in interpreting and coding for all manners of treatment delivery, and treatment management, and the nuances of the measures taken.
- Ability to code appropriately for services in a manner that interconnects services across all patient-related claims. *Note: It is essential that physicians provide documentation which consistently supports the chain of services provided for each individual patient.
ICD-10-CM and ICD-10-PCS proficiency
ICD-10 proves to be a challenge radiation oncologists. Even the most experienced coders have found the need for expanded data and information sets in order to navigate the highly detailed coding perimeters. Providers must familiarize themselves with the ICD-10-CM codes that pertain to their specialty and work to provide the needed clinical documentation accordingly. With effective communication, and a collaborative effort between the physician and the staff, the demands of ICD-10-CM will become a standard best practice in your internal operations.
Most radiation oncology codes reported fall under the scope of ICD-10-CM (clinical management). ICD-10-PCS (Procedure Coding System) codes are used only for inpatient procedure coding with respect to radiation oncology. The documentation requirements with ICD-10 for radiation oncology are more descriptive in nature and require increased documentation to include:
• Type of radiation
brachytherapy, beam radiation, stereotactic radiosurgery, etc.
• Location of treatment site and laterality
Electrons, photons, heavy particles, contact radiation
• Radioactive isotope
low osmolar, high osmolar, etc.
Timely, accurate coding is important in radiation oncology as a means to proper reimbursement, limiting the risk of audit, decreasing instances of claim rejection, optimizing reimbursements, and ensuring compliance with quality reporting measures and all regulations. PDN’s certified radiation oncology coding specialists are exceedingly capable in assessing evaluation and management documentation, are knowledgeable in all levels of radiation oncology treatment and services, provide a consistent pattern of accurate and compliant results, are proficient at working with electronic medical records, and would ultimately be of great benefit to any radiation oncology practice.