CPT Code 77470 — Billing and Coding for Radiation

Touseef Riaz

March 16, 2022

CPT Code 77470

CPT Code 77470 for Radiation Oncology

CPT stands for Current Procedural Terminology (CPT) codes and is one of the most commonly used code sets. CPT 77470 code is for special radiation treatment and falls under chapter 9 of CPT codes. This chapter comprises codes from 70000 to 79999 and covers radiology services. What is CPT code 77470? CPT code 77470 is an add-on code and treatment management for radiation procedures that require extensive planning. This code is reported with other radiation treatment management such as:

  •  Planned combination with Chemotherapy
  •  Total body irradiation
  •  Hyperthermia
  •  Brachytherapy
  •  Any other combined therapy
  •  Stereotactic radiosurgery

77470 CPT Code Description:

CPT code 77470 falls in the Radiation treatment management of the Radiation Oncology Treatment code set. This code is maintained by the American Medical Association (AMA). According to AAPC, CPT 77470 is the procedure code in which the physician performs:

“Special radiotherapy procedures requiring special consideration from the provider in the overall management of radiotherapy treatment.”

CPT Code 77470 — Billing and Coding for Radiation

Where to use CPT code 77470?

77470 CPT code is an add-on code where healthcare provider performs special radiation therapy. It requires special considerations from the practitioner for the overall management of radiotherapy treatment.

As mentioned, 77470 is an add-on code meaning it must be used with other radiation treatments like:

–  CPT Code 77427, radiation treatment management, five treatments

–  CPT Code 77499, unlisted procedure, therapeutic radiology treatment management – that doesn’t contain any other specific code.

Common CPT codes for Radiation Therapy:

Some of the common CPT codes for radiation therapy include:

– CPT Code 77431:

Complete radiotherapy treatment course divided into one or two small doses called fractions. This code covers one or two fractions only, and these two fractions must be given over a number of weeks.

– CPT Code 77432:

Stereotactic radiotherapy treatment involves the use of a three-dimensional coordinate system by the physician. It is used to locate small targets or lesions inside the brain. It involves the complete course of stereotactic radiotherapy treatment.

The small targets are destroyed with precision using externally generated ionized radiation. There’s only one session for this treatment, and this code represents a professional component only.

– CPT Code 77435:

Stereotactic body radiotherapy treatment involves the use of a three-dimensional coordinate system by the physician. It is done to locate small targets or lesions inside the body except for the brain and spinal cord. The entire course of treatment does not exceed five fractions and targets one or more lesions. The small targets are destroyed with precision using externally generated ionized radiation. One or more lesions are targeted, and the entire course of treatment does not exceed five fractions.

– CPT Code 77469:

Intraoperative radiation treatment in which radiation therapy is directly administered in the form of irradiating X–rays or electron beams. This treatment is done to the exposed tumor during surgery.

Common challenges faced in Radiation Oncology billing practice:

Medical billing is a critical part of any physician and healthcare practice as it directly impacts their revenue cycle. Using the right codes, right modifiers, and timely submissions results in lesser claim denials. Following are the common challenges faced by radiation therapy:

  •  Incomplete or inaccurate claims:

Inaccurate or incomplete claims are one of the most common billing errors across all specialties. The medical claim must have all essential patient information; patient name, gender, date of birth, and the medical emergency.

Miscoding and human errors like typing errors result in medical claims being denied for radiation oncology. There can be several coding errors like missing a character, incorrect code, repeating a code, etc. Some of the most common coding errors include:

  • Submitting a wrong CPT code for radiotherapy
  • Incorrect ICD-10-CM code
  • Inaccurate patient data or medical information
  •  Coding errors like upcoding or under coding:

Upcoding is a coding error where codes for a more expensive service are submitted than the service that was actually performed. Whereas under coding is the opposite, it involves the use of lesser codes in the patient’s medical bill. Both of them are unethical practices in medical billing.

Errors like these result in claim denials and impact the healthcare practice’s reimbursement rate and revenue cycle.

  •  Incomplete or inaccurate documentation and patient records:

Lack of information or incorrect patient documentation results in errors in the medical claim. Moreover, it also leads to wrong CPT codes, resulting in claims being denied or rejected. Except for this, the patient data also needs to be organized. As in case of a claim denial or a possible audit, complete documentation is required.

Tips for Overcoming the Challenges Faced During Radiotherapy Billing:

The abovementioned are the billing challenges faced by radiation therapy practices. Following are some of the ways and factors to improve medical billing:

  •  Verify the patient information, insurance coverage, and eligibility criteria.
  •  Keep accurate, complete, and organized patient medical data and documentation.
  •  Most important, based on the above two, submit clean claims, reduce the errors, avoid any and all kinds of coding mistakes. Make sure of complete and accurate documentation as well as timely submissions.

Hence, lesser medical claim denials lead to faster payments, a higher reimbursement rate, and an improved revenue cycle. Moreover, healthcare providers can also choose to outsource their medical billing services to a well-reputed medical outsourced billing company. Companies like UControl Billing have a team of highly professional and trained medical billing specialists. Outsourcing medical billing services have several benefits, including:

– Providing the healthcare practices with timely follow-ups

– Reduced errors

– Improved revenue cycle

– Higher clean claim rate

– Higher reimbursement rate

Radiation Therapy vs. Chemotherapy:

Both Chemotherapy and radiotherapy are treatments for cancer, among various other treatments. The goal of both treatments is the same (to treat cancer); however, the way of delivering or treating differs. For most types of cancer, these two are considered to be the most effective treatments.

Chemotherapy is the treatment option that involves medications via the mouth or via injection infused through the vein. Depending on the type of cancer treatment, Chemotherapy is the option that comes with several side effects.

Radiotherapy aims to target and damage more cancerous cells and as few normal cells as possible. However, radiation therapy involves only targeting the tumor or cancer directly via intense high beams. These radiations alter the DNA of cancer cells, destroying their ability to grow or divide, shrink and eventually die. Radiation therapy only targets the tumor; therefore, it has lesser side effects than Chemotherapy.

What is the purpose of radiation therapy?

Many cancer patients receive radiation therapy in their treatment plans. Not only cancer but non-cancerous cells are also affected by radiation therapy. Radiotherapy has been known to be a useful option for cancer. Radiation therapy can be of two types, external beam or internal beam. Now the type of radiation therapy as the best treatment option depends on various factors, including:

– The location of the tumor in the body

– Type of the cancer

– Tumor size

– The tumor’s location with respect to the normal cells, particularly the tissues sensitive to radiation.

– Medical history and general health

– Age

– Other medical conditions

– If you are or had any other treatments for your cancer

Use of radiation therapy for cancer patients:

Healthcare physicians suggest radiotherapy depending on the type of cancer, at different times, and for various reasons during the treatment. They include:

– As the primary treatment for cancer

– To shrink the cancerous cells or tumor before the surgery, also known as neoadjuvant therapy.

– Stopping the growth of the rest of cancer cells after surgery. This is also known as adjuvant therapy.

– As a combination treatment along with other treatments like Chemotherapy.

– To alleviate the symptoms caused by cancer at an advanced stage.

Who provides the radiotherapy treatment?

Healthcare professionals, including: provide radiation therapy

– Radiation Oncologists

– Radiation therapists

– Medical radiation physicists

– Dosimetrists

– Radiation therapy nurses

Risks associated with Radiation Therapy:

Like every other treatment option, radiation therapy also has side effects. Following are some of the common side effects of radiation therapy depending on the body part under treatment:

Any part of the body:

– Hair loss (at the treatment site)

– Skin irritation at the treatment site (any part of the body)

– Fatigue

Head and Neck:

– Nausea

– Dry mouth and mouth sores

– Problem swallowing food

– Different tastes of food

– Tooth decay

– Thickened saliva

Chest:

– Cough

– Shoulder stiffness

– Shortness of breath

– Problem swallowing food

Abdomen:

– Diarrhea

– Nausea

– Vomiting

– Bowel cramping

– Loss of appetite

Pelvis:

– Frequent urination

– Bladder irritation

– Diarrhea

Why does radiation therapy cause side effects?

Radiation therapy involves destroying cancerous cells using high doses of radiation. Side effects of radiation therapy vary among people; some experience a few, whereas some experience none. The major side effect is associated with damage to the healthy cells and tissues at the treatment site. Over the years, radiation therapy has been made more precise, resulting in lesser side effects.

Frequently Asked Questions (FAQs)

What is the CPT code 77470 in medical billing?

CPT 77470 code is for special radiation treatment and falls under chapter 9 of CPT codes. This chapter comprises codes from 70000 to 79999 and covers radiology services. 77470 CPT code is an add-on code and treatment management for radiation procedures that require extensive planning.

What are common CPT code 77470 errors?

Medical billing is a critical part of any physician and healthcare practice as it directly impacts the reimbursement rate. Some of the most common errors related to radiotherapy are the use of incorrect codes, incomplete documentation, and upcoding or under coding. Using the right codes, right modifiers, and timely submissions following 77470 CPT code guidelines, results in lesser denials.

What is radiation therapy?

Also known as radiotherapy is a cancer treatment. This therapy uses radiations or intense energy beams to kill cancer cells. This destroys the ability of cancer cells to divide or grow by damaging their DNA. Mostly, x-rays, gamma rays, or protons are used to damage the cancer cells. Radiation therapy also affects the normal or non-cancerous cells in the surrounding. But these cells most often tend to recover and come back to normal.

What is the denial code for CPT code 77470?

Denial codes in medical billing involve codes providing information based on which the medical claim was denied. There are various reasons behind claim denials, e.g., incorrect coding. The use of the wrong ICD-10-CM code for the radiation therapy treatment provided can also lead to the claim being denied.

https://www.cms.gov/files/document/chapter9cptcodes70000-79999final11.pdf

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