1. August 2005Copyright Churchill Consulting, Inc. 1992-20051 Welcome to Churchill Consulting Inc.’s CODING HELP APPLICATION ®

2. August 2005Copyright Churchill Consulting, Inc. 1992-20052 How Can CCI’s DIRECTREES Help You?  DIRECTREES ®  DIRECTREES ® provides a dynamic table of contents  DIRECTREES ®  DIRECTREES ® provides a comprehensive look-up index  DIRECTREES ®  DIRECTREES ® provides powerful search capabilities to quickly provide you with in-depth information pertaining to specific codes DIRECTREES ® DIRECTREES ® was developed by Churchill Consulting, Inc. to provide a guide to accurate Radiation Oncology Coding. CCI’s copyrighted Directory Trees have been used to create a User- Friendly electronic Help program that provides you with the opportunity to query information for specific billing codes and/or treatment regimens on your own computer. The electronic Directory Trees are formatted to follow standard treatment procedure sequences for ease of use.

3. August 2005Copyright Churchill Consulting, Inc. 1992-20053 What’s Contained in DIRECTREES ® ? T R U N C DIRECTORY T REES R ULES of THUMB RV U & REIMBURSEMENT SUMMARIES ELECTRONIC N EWSLETTER C ODING SUMMARIES

4. August 2005Copyright Churchill Consulting, Inc. 1992-20054 What’s Contained in DIRECTREES ® ? Diagnosis Specific Directory Trees & Coding Summaries Skin Abdomen Bone Brain Breast Esophagus Lung Head & NeckLymphoma Pelvis Brachytherapy CCI’s Rules of Thumb Reporting the 77000 CPT CodeReporting the E&M and Professional Codes Summary of Billing Questions & Answers IMRT

5. August 2005Copyright Churchill Consulting, Inc. 1992-20055 What’s Contained in DIRECTREES ® ? RVU & Reimbursement Summaries (more Diagnoses to be Added in future releases) Lung Breast Brain Head & Neck Prostate Newsletters 2005 Let’s Get Started…... 2004 2002 2003 2000 2001

6. August 2005Copyright Churchill Consulting, Inc. 1992-20056 DIRECTORY T TREES

7. August 2005Copyright Churchill Consulting, Inc. 1992-20057 DIRECTREES  When DIRECTREES ® is initially launched a screen will appear with a brief introduction.

8. August 2005Copyright Churchill Consulting, Inc. 1992-20058 DIRECTREES  As you scroll down on this initial screen, you will find a selection of choices for using the DIRECTREES ® Coding Help Application.  We will start by selecting the Directory Trees option. Please note that each option listed on this screen is also listed in the Toolbar at the top of the page. This allows you to navigate through DIRECTREES ® from anywhere in the application. Click Here

9. August 2005Copyright Churchill Consulting, Inc. 1992-20059 DIRECTREES  A Screen will appear with the index of treatment areas that are available in the Directory Trees option.  In this example, Brain was selected. Click Brain

10. August 2005Copyright Churchill Consulting, Inc. 1992-200510 DIRECTREES  A Screen will appear with a list of treatment options within the Brain. Reimbursement Graphs and Summaries are also available for all Brain Options from this initial page.  In this example, 142 Brain: Complex with 3D Boost was selected. Click General Abdomen Click Here

11. August 2005Copyright Churchill Consulting, Inc. 1992-200511 DIRECTREES òAt the top of all Trees there will be a link to the corresponding Coding Summary. For the Trees that have Completed Reimbursement Summaries, those will also be listed.

12. August 2005Copyright Churchill Consulting, Inc. 1992-200512 DIRECTREES òThe parameters that are reflected in the selected Tree are listed. Information will include immobilization, contrast, type of planning, special calculations, etc.

13. August 2005Copyright Churchill Consulting, Inc. 1992-200513 DIRECTREES  As you scroll through the Directory Tree that you have selected you will come to the Prescription Parameters Section. Trees are based on the doses that were found to be the most customary dose ranges among CCI's interviewed physicians.  Doses are for demonstration purposes only and may or may not reflect the doses prescribed by your physicians.

14. August 2005Copyright Churchill Consulting, Inc. 1992-200514  The “Physician Elements Section” follows the prescription section in the Tree and includes the Consultation Level, Treatment Planning Level and the Special Treatment Procedure Codes.  On the left-hand side of the screen the appropriate code is listed with the descriptor of who should bill this code and the number of times it should be billed. 99244  The 99244 is the Customary Code to be billed. For Example, Line one in the Physician Code reads 99244 26 x 1. DIRECTREES 26  The 26 denotes it is a Physician Code. x1  The number of times the Code should be billed.

15. August 2005Copyright Churchill Consulting, Inc. 1992-200515 DIRECTREES  A DG, or Documentation Guideline, is provided for every code on the right side of the screen. The Documentation Guidelines provide detailed information on coding criteria and documentation requirements to assist you in coding properly.  In this case we clicked on DG92 to view these Documentation Guidelines. Click Here

16. August 2005Copyright Churchill Consulting, Inc. 1992-200516 DIRECTREES  DG92 Complex Treatment Planning Criteria

17. August 2005Copyright Churchill Consulting, Inc. 1992-200517 DIRECTREES  Each Directory Tree will have a Section for choosing Simulation Levels. Because some departments have a dedicated CT in the Department and others use CT in Radiology, there are 2 options listed. Select the option that fits your department.  All Links will be denoted by a key (  ) symbol and will be listed in purple underlined text.  In this example we have selected  Link 6: Initial Complex Simulation followed by CT TX Planning Click Here

18. August 2005Copyright Churchill Consulting, Inc. 1992-200518 DIRECTREES  The link page will appear, providing detailed information for your selection. If the procedure performed is not exactly the same as the narrative description you chose, just click on the link that best fits your scenario.  You may print this page by clicking the Print button on the toolbar at the top of the screen.  To return to your Directory Tree, click the "Back" button on the toolbar.

19. August 2005Copyright Churchill Consulting, Inc. 1992-200519 DIRECTREES  Each Directory Tree will have an Initial Encounter Phase 1 and Phase 2. Two scenarios are demonstrated; CT in Radiology and CT in Department. Choose the appropriate section for your department.

20. August 2005Copyright Churchill Consulting, Inc. 1992-200520 DIRECTREES  The treatment weeks are split into 5 fraction periods regardless of the amount of days elapsed.

21. August 2005Copyright Churchill Consulting, Inc. 1992-200521 DIRECTREES  If the selected Treatment Regimen has a boost, the boost section will be listed following the initial Treatment Weeks.

22. August 2005Copyright Churchill Consulting, Inc. 1992-200522 R RULES OF THUMB

23. August 2005Copyright Churchill Consulting, Inc. 1992-200523 DIRECTREES  The Next option in the main menu is Rules of Thumb.  When you select the Rules of Thumb option from the main menu or the “Thumb” option in the Toolbar, a list of 3 categories appear.  In this example, we selected Reporting the 77000 CPT Codes. Click Here

24. August 2005Copyright Churchill Consulting, Inc. 1992-200524 DIRECTREES  The top section of this page includes information that will be useful in reporting many additional Radiation Oncology codes outside of the 77000 and E&M Codes.

25. August 2005Copyright Churchill Consulting, Inc. 1992-200525 DIRECTREES  Below the Informational section, a list of all the 77000 codes pertaining to Radiation Oncology will appear (note, only a small portion of the codes available are shown above).  To view further information for a specific code, click on either the code or its description.  In this example, 77261-77263 was selected. Click on the Code or the Description

26. August 2005Copyright Churchill Consulting, Inc. 1992-200526 DIRECTREES  Each code listed has in depth information about the proper usage of that code. All source information is documented.  Code information can also be accessed by using the “search function” or the “index function.”

27. August 2005Copyright Churchill Consulting, Inc. 1992-200527 REIMBURSEMENT & U RVU SUMMARIES

28. August 2005Copyright Churchill Consulting, Inc. 1992-200528 DIRECTREES  The next section listed is the RVU & Reimbursement Summaries. These Summaries are currently available for the Prostate, Brain, Breast, Lung & Head & Neck. More diagnoses will be added as they become available.

29. August 2005Copyright Churchill Consulting, Inc. 1992-200529 DIRECTREES  All RVU & Reimbursement Summaries are broken out into Technical, Professional and Global sections and have links back to the corresponding Tree.

30. August 2005Copyright Churchill Consulting, Inc. 1992-200530 N NEWSLETTERS

31. August 2005Copyright Churchill Consulting, Inc. 1992-200531 DIRECTREES  The Newsletter section contains all Newsletters published by Churchill Consulting going back to 2000.

32. August 2005Copyright Churchill Consulting, Inc. 1992-200532 C CODING SUMMARIES

33. August 2005Copyright Churchill Consulting, Inc. 1992-200533 DIRECTREES  The Coding Summaries are a condensed at-a-glance version of the Directory Trees to help in the auditing process.

34. August 2005Copyright Churchill Consulting, Inc. 1992-200534 DIRECTREES  The Detailed Coding Summaries are listed in the order that the codes appear in the Trees and include optional coding.

35. August 2005Copyright Churchill Consulting, Inc. 1992-200535 DIRECTREES  The Condensed Coding Summaries are listed in numerical order with the total number of each code demonstrated in the Directory Trees.

36. August 2005Copyright Churchill Consulting, Inc. 1992-200536 DIRECTREES The software product known as DIRECTREES ®, designed and copyrighted by Churchill Consulting, Inc., will be provided directly to the Client on CD- ROM in hlp. language. This format is viewable on most Windows based systems and can be loaded on a standalone PC or on a central file server, depending on the licensing agreement. DIRECTREES ® will provide you with the most comprehensive coding tool available in the industry.

37. August 2005Copyright Churchill Consulting, Inc. 1992-200537 Thank You for taking the time to view Churchill Consulting Inc.’s DIRECTREES ®. If you would like more information on the DIRECTREES ® product, please contact CCI. You may download a limited trial version directly from our website. Churchill Consulting, Inc. 384 Route 148 Killingworth, CT 06419 Phone: 860.663.5630 Fax: 860.663.5633 Email: ChrchlCCI@aol.com www.ChurchillConsulting.com