Radiation Oncology Billing and Coding Advice

Some important considerations about radiation oncology billing and coding...

Radiation services are typically very technical components of medical services, which are used to diagnose and locate certain medical conditions. These conditions range from cancers and tumors to heart conditions and fractures. As such, each radiation therapy service is specifically used to diagnose the condition from which the patient is suspected to suffer.

In other words, there are many different types of radiation services.

Some of them will be used in hospitals, others in doctor's office or clinics, and still others will be used in Ambulatory Surgery Centers (ASCs) and Skilled Nursing Facilities (SNFs).

No matter where the radiation service is performed, it's almost always used to diagnose and locate certain medical conditions such as cancerous tumors or fractures.

This means that there are many different types of radiation services which are used to diagnose the condition of the patient, based on his or her symptoms.

Because many radiation therapy services are specially used to diagnose oncological (or cancerous) conditions, many times radiation therapy billing guidelines also include radiation oncology billing guidelines. These are special services used to locate and determine the condition of tumors and other cancerous masses or conditions.

Types of radiation procedures

There are many different types of radiation procedures. Each is used to visualize a certain field or image in the human body in order to locate and diagnose a medical condition.

These types of procedures include:

• X-Rays
• EKGs and ECGs
• Computerized Axial Tomography (CT) procedures
• Magnetic Resonance Imaging (MRI) procedures
• Nuclear medicine
• Bone Mass Measurements (BMMs)
• Positron Emission Tomography (PET) scans

Each one of these types of scans are completely different, using different technology for the field of visualization, as well as to diagnose different medical conditions. Some scans can be performed in a regular medical office, whereas other scans have to be be performed in a specialized facility or hospital.

Each one of these scans is also billed differently, using the correct CPT (Current Procedural Terminology) code (based on the individual procedure).

Professional v. Technical component

Depending on the location in which the radiation service was performed, the provider who performed it, and the interpretation of the report, you'll have to add certain medical coding modifiers .

These tell the insurance company how to reimburse the procedure.

The following 2 modifiers give the insurance company more information about the procedure and tell the insurance company how they need to pay for the service:

1. PC: Professional Component. This modifier is used when the radiation service was performed in a typical medical setting, like a doctor's office.

   You can use this modifier for any type of medical provider in any medical setting. Usually, you'd use it when the doctor or attending physician performs a radiation service, who completes and interprets the results of the service.

   When you use this modifier the insurance company will pay the procedure under the physician fee schedule for the service.

2. TC: Technical Component. If you use this modifier, the insurance company billed will pay under the technical component fee schedule rather than the physician fee schedule.

   In other words, if you use this modifier, the insurance company would pay only the technical component of the procedure. The payment could be less than if paying for the professional component. Usually you'd use this modifier when the radiation service was performed in the hospital as part of additional procedures, or in an outpatient facility or clinic.

Depending on the code you're using, it may or may not be necessary to include this modifier. Some codes include both the professional and technical components - others don't. As always, though, the accuracy of your code will depend on the actual procedure that was performed on the date of service.

Specific Requirements

There are many other specific requirements in radiation oncology billing. So many, in fact, that it's impossible to touch on their complexity in this short article.

As mentioned before, some radiation therapy procedures are for simple diagnostic tests, such as x-rays to diagnose a fracture.

These radiation services are more like taking a picture, with the radiation therapist or doctor determining whether or not there is a fracture.

On the other hand, other radiation therapy services include ingestion of a substance in order to better visualize a contrast between different parts of the body.

These types of tests are for more serious internal medical conditions, such as cancerous tumors or pulmonary embolisms. Instead of simply taking a picture of the body, their accuracy depends on the way the picture was taken, any procedures that the patient had to perform before the radiation service, and any other interpretation of a more complicated graphic or recorded report.

Each radiation service must be very carefully coded, depending on the service that was provided, and whether or not it was a simple service, such as an x-ray, or a more complicated service, such as an MRI.

This is because in radiation oncology billing, many procedure codes are specifically itemized. It's especially important to make sure you find the exact code that describes the exact procedure that was performed, taking into account any of the more complicated methods that may or may not have been used for the procedure.

Many radiation procedure codes automatically include other procedure codes, such as interpretation and report, but others may not.

This is where your specific expertise in the medical billing and coding fields will become very important, as you'll be able to determine exactly the right codes, as well as exactly the way they need to be billed.

This ensures the highest rates of payment for you and your facility or provider, as well as reflect highly on your professional skills in the medical billing and coding fields.

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