Lung CancerTargeted energy such as X-rays and radioactive substances are used in radiation therapy to destroy cancer cells and tumors, and alleviate certain symptoms related to cancer. This therapy can be used as a primary treatment to destroy cancer cells, or along with other treatments to stop the growth of cancer cells. It is also used before another treatment to shrink a tumor or after another treatment to prevent the growth of any remaining cancer cells. Radiation therapy can also help relieve symptoms of advanced cancer.

Radiation oncology medical billing and coding for cancer including lung cancer is done on the basis of the following aspects that show the sequence of the process of care. Medical codes related to these processes are to be accurately reported on the claim form.

  • Consultation
  • Preparing for treatment
  • Medical radiation physics, dosimetry, treatment devices, and special services
  • Radiation treatment delivery
  • Radiation treatment management
  • Follow-up care management

Lung Cancer – Symptoms and Treatment

Lung cancer (both small cell and non-small cell) is the second most common type of cancer among both men and women in the United States. The American Cancer Society (2014 statistics), reports about 224,210 new cases of lung cancer (116,000 in men and 108,210 in women) in the United States. It is estimated that more than 159,260 deaths occur from this disease and this accounts for about 27% of all cancer deaths. This disease mainly occurs in older people as about 2 out of 3 people diagnosed are 65 years or older. The average age at the time of diagnosis is about 70 years. Many patients suffering from this disease undergo radiation therapy techniques that potentially reduce the side effects of this disease.

Screening Procedures – Helps in Early Lung Cancer Detection

If cancer is suspected, a radiation oncologist will perform different screening procedures such as high-powered chest X-rays, chest CT scan with infusion of radioactive materials, sputum cytology, bronchoscopy and fine-needle aspiration (FNA) biopsy of the lung. These screening tests help to detect the disease in its early stages and begin treatment early so as to avoid further complications.

There are different types of radiotherapy treatment such as radionuclide therapy, external beam radiation therapy (EBRT) and brachytherapy and depending upon the intensity of the disease a specific type of treatment modality is chosen. Oncologists can bill for the different therapies they provide that are reimbursable. As the process of radiation oncology coding is complex, physicians should have adequate knowledge about medical coding of radiation oncology services to ensure correct reimbursement.

The following are some of the applicable codes.

CPT Codes

  • 77424 – Intraoperative radiation treatment delivery, x-ray, single treatment session
  • 77425 – Intraoperative radiation treatment delivery, electrons, single treatment session
  • 77469 – Intraoperative radiation treatment management
  • 77761 – 77763, 77776-77778, 77789 – LDR Brachytherapy
  • 77785 – 77787 – HDR Brachytherapy
  • 77418, 0073T – Intensity modulated treatment delivery (IMRT) treatment delivery

ICD-9 Code

  • 231.2 – Carcinoma in situ of bronchus and lung

PORT Improves Survival Rates in Resected Non-small Lung Cancer Patients

ScienceDaily reports that post-operative radiation therapy significantly improved the overall survival rate of patients suffering from resected non-small lung cancer. The research paper presented at the "2014 Chicago Multidisciplinary Symposium in Thoracic Oncology" reports that patients who received post-operative radiation therapy (PORT) after surgery happen to live an average of 4 months longer when compared to those patients who didn’t receive the same. The study was jointly sponsored by the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and the University of Chicago Medicine.

As part of the study, researchers analyzed the medical records of non-small cell lung cancer patients who underwent treatment at the National Cancer Data Base (NCDB) during the period 2004 – 2006. They obtained data for patients who had surgically resected non-small lung cancer with pathologically involved N2 (pN2) lymph nodes, and those who received chemotherapy.

The database was further evaluated and patients with positive margins, incomplete survival data, patients treated with Cobalt-60, non-beam or neoadjuvant therapy and patients who did not receive chemotherapy, histology other than NSCLC were excluded. As part of the assessment, a multivariable Cox proportional hazards model was used to identify the potential factors associated with overall survival (OS). Inverse probability of treatment weighting (IPTW) using the propensity score was also implemented so as to reduce the biased treatment selection. After the evaluation, about 2,115 patients were found to meet all of the study criteria.

  • Out of the 2,115 patients evaluated, 918 patients (43%) received PORT, 1,197 patients (56.6%) were not treated with PORT.
  • Patients who were treated with PORT showed significant improvements in the overall survival (OS) with a median survival time of 42 months when compared to just 38 months for patients who had not undergone PORT treatment.
  • It was found that multivariable factors such as female gender, higher income, lower T state, adenocarcinoma histology, urban/rural setting vs. metropolitan setting, lymph node involvement and age (younger) contributed to a higher and improved overall survival.

The study results signify the value of PORT for non-small lung cancer patients with involved mediastinal lymph nodes. It highlights the fact that PORT can significantly improve the survival rates of patients with modern radiotherapy equipment and treatment techniques. Researchers claim in addition to chemotherapy, PORT should be considered as a treatment for resected non-small lung cancer.