This page addresses follow-up questions and additional information pertinent to our webinar
Introducing Radiology Oncology.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Has CMS published a start date for the proposed Radiation Oncology Model, and where can additional details and updates be found?
A: CMS has not published any updates concerning the model since August 25, 2022, when it was communicated that per the Final Rule, the model start date would be delayed. Please refer to the link below for updates and model information. Model education will be forthcoming once a release date has been determined.
Q: An IMRT plan satisfies all criteria for 3-D. Can it be billed as 3-D for cases when IMRT is denied by insurance?
A: IMRT plans should not be billed as 3-D. The case should be billed if the physician feels medical necessity supports IMRT planning. Review Local Coverage Determinations (LCDs) and payer policies specific to IMRT requirements.
Q: How do you code for more than one body area being treated, such as concurrent treatment to the chest and to the whole brain?
A: In order to provide radiation to two separate areas, two separate plans with corresponding dose calculations and treatment devices will be required. Although treatment will be delivered to two separate sites, only one daily treatment delivery CPT code may be reported. The higher-level delivery code should be reported.
Q: How do you code for more than one body area being treated, such as concurrent treatment to the chest and to the whole brain?
A: In order to provide radiation to two separate areas, two separate plans with corresponding dose calculations and treatment devices will be required. Although treatment will be delivered to two separate sites, only one daily treatment delivery CPT code may be reported. The higher-level delivery code should be reported.
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Tamara Jones, RHIT, CPC, CPMA, CRC
Senior Coding Quality Auditor
Tamara brings over 15 years to Haugen’s team of Coding Quality Auditors & educators. She began her career as a denials specialist, instilling the importance of accuracy from the start! Tamara has a very investigative, analytical mindset which guided her through the roles as claims and coding managers, finding her fit as an auditor. Tamara enjoys reviewing coding assignments, digging into the clinical documentation, and working with clients to share opportunities for improvement. She has identified opportunities for clients to improve clinical documentation, identify deficiencies in processes or guidelines, and provide education to help their staff excel!
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