Prostate cancer, the most common form of cancer in American men, is more prevalent in men over age 65. The American Cancer Society estimates that in 2014, about 233,000 new cases of prostate cancer will be diagnosed and about 29,480 men will die of prostate cancer. Many patients with this disease are benefiting from radiation therapy techniques that reduce side effects and may lead to higher cure rates. A radiation oncologist or urologist performs this radiotherapy that involves several types of treatment, including the use of high-powered X-rays, placement of radioactive materials into the body or injection of a radioactive substance into the bloodstream.
Screening tests can detect prostate cancer at an early stage and thus enables early treatment without complications. Though there is no routine screening program for this cancer type, men often opt to be screened for the disease with a prostate-specific antigen (PSA) test. However a recent European study reveals that while routine prostate cancer screening reduces deaths from the disease by more than a fifth, it also leads to high rates of over diagnosis. This can lead to overtreatment and common side effects, including incontinence and impotence.
Radiation treatments are used for primary treatment of localized prostate cancer and for the secondary treatment for cancer recurring within the region of the prostate and for relief of pain and other symptoms related to prostate cancer that has spread to other parts of the body.
External beam radiation therapy (EBRT), brachytherapy and radionuclide therapy are different types of radiation therapy. This therapy uses high-energy rays or particles to kill cancer cells.
Radiation oncologists can bill for the various therapies they provide that are reimbursable. Radiation oncology coding can be complicated and proper medical coding of radiation oncology services is vital for on-time reimbursement.
CPT codes for submitting accurate claims for reimbursement include the following.
- 77424 and 77425 Intraoperative Radiation Therapy (IORT)
- 77261-77263, 77776-77778 – LDR Brachytherapy
- 77785-77787 – HDR Brachytherapy
- 77418, 0073T – IMRT treatment delivery
Reimbursement for CPT codes under this physician fee schedule is composed of three components: physician work relative value units (RVUs), practice expense RVUs and malpractice RVUs. Medicare, on July 3, 2014, proposed rates for the 2015 physician fee schedule that would cut radiation oncology by 4 percent and radiation therapy centers by 8 percent.