Coding an Additional Treatment Site

Sometimes during treatment, a new tumor site is identified that needs treatment. These cases present their own unique set of challenges in the coding and reimbursement areas. Listed below are some items to consider when coding and documenting an additional site of treatment.

1. Watch for bundling edits between the initial site’s daily treatments and the new site’s simulation and planning services. Append any modifiers necessary to differentiate between normally bundled services when allowed.
2. Watch the treating diagnosis on each claim billed. Make sure the correct treating diagnosis is applied to each line item. This will let the payer further know why normally bundled services should be paid separately in this situation.
3. Only bill one daily treatment code per day, even though 2 sites are being treated. Treating one site in the AM and the other site in the PM does not constitute BID (twice a day) treatment. If treating one site with IMRT and the other with conventional treatment bill the IMRT daily treatment code.
4. An additional clinical treatment plan can be billed, if properly documented, for the second site.
5. Speaking of proper documentation, make sure each document in the medical record has the correct site and diagnosis listed on it. This will be especially important if any services need to be appealed.

Getting proper reimbursement for treating a second site during an established course of treatment can be tricky. These tips will set you on the best path for getting paid for all services.

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