Missing Documentation for Radiation Oncology and Brachytherapy Services
Current Procedural Terminology (CPT®) listings for radiation oncology provide for teletherapy and brachytherapy to include initial consultations, clinical treatment planning, simulation, medical radiation physics, dosimetry, treatment devices, special services, and clinical treatment management procedures. They include normal follow-up care during course of treatment and for three months following its completion. Appropriate documentation of these services is paramount in order to establish the indications and limitations of WPS Medicare coverage.
In recent Comprehensive Error Rate Testing (CERT) contractor medical record requests for radiation oncology services, we have learned that in some cases not all of the documentation is submitted to support the services billed. This can result in CERT error assessments or the need for additional follow-up contacts to obtain the necessary documentation.
When responding to requests for documentation for these services, please review the documentation requirements in the applicable Local Coverage Determination (LCD) policy and make certain you provide all the needed information in order for the contractor to ascertain payment of the proper benefits. The billing provider has the ultimate responsibility to obtain and provide copies of medical record documentation, even if the records are housed elsewhere (i.e. radiology department).
If you bill these services to Medicare, please visit the link below and select the applicable Local Coverage Determination (LCD) policy in order to access more specific information regarding documentation requirements.
For easy access to WPS Medicare LCD L30316 - Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) or WPS Medicare LCD L30320 - Brachytherapy, simply go to the following Web page and enter the applicable document ID (L30316 or L30320) in the search box:
http://www.cms.hhs.gov/mcd/search.asp?from2=search.asp& 
Page Last Updated: Thursday, 18-Mar-2010 05:48:32 CDT
