Reimbursement Coding Tips

2020 Radiation Oncology Reimbursement Reminders (RORR)

By Jessica Adams, CCA, ASTRO Health Policy Analyst

To assist in correct coding for radiation oncology, ASTRO has a number of resources for coding and billing professionals seeking advice on the proper application of Current Procedural Terminology (CPT) codes. In addition to coding FAQs, coding guidance articles and coding updates, which provide information on a variety of coding topics, ASTRO also circulates reimbursement reminders, called Radiation Oncology Reimbursement Reminders (RORR), to help practices address common coding and coverage issues. The reminders below address common coding questions received by ASTRO from both members and payer entities.

  1. Submit all codes, including treatment delivery, special services and image guidance codes with every claim.

    Payers report that some practices bill for all services delivered in a course of treatment on every claim that are not necessarily performed during each individual treatment session. Claims are submitted containing codes for treatment delivery, special dosimetry, special teletherapy port plan, special medical radiation physics consultation and image guidance radiation therapy each time.

    Not all parameters of treatment are completed each week because the clinical course of care may differ due to variation in treatment modality and individual patient requirements. Thus, practices should not bill for all services delivered during a course of treatment at each treatment visit, but rather bill for the services delivered during the specific visit. ASTRO’s 2020 Radiation Oncology Coding Resource states: “Supporting documentation, including ICD-10-CM codes, is needed to justify the distinctions between codes that represent apparently similar activity but different levels of effort and complexity. Each time a procedure is reported, its level of effort and complexity should be appropriately documented. Many of the procedures within each phase of care will be carried to completion before the patient’s care is taken to the next phase.” For more information, see page 28 of the 2020 ASTRO Radiation Oncology Coding Resource

  2. Use 77014 for CT simulations instead of CT image guidance.

    Some practices appear to confuse the services described by CPT codes 77280-77290 Therapeutic radiology simulation-aided field setting; simple-complex and CPT code 77014 Computed tomography guidance for placement of radiation therapy fields. Payers shared that they receive claims that include CT image guidance when the service delivered was actually CT simulation.

    This issue may stem from an ASTRO CPT update in 2014. ASTRO’s 77014 Coding Guidance explains: “Since the development of the simulation codes, there have been significant changes in the process of care for physician and other qualified health care professionals, as well as the nature of the equipment utilized. For example, fluoroscopic simulators have largely been replaced with dedicated CT scanners and related workstations. As a result, CPT code 77014 is now included in the simulation codes (CPT codes 77280-77290).”

    Though 77014 is grouped with the simulation codes, it still represents image guidance services. Practices should be sure that the documentation submitted with each claim supports the code being billed.

  3. How to code for two treated with Stereotactic Body Radiation Therapy (SBRT).

    Payers and practices alike frequently request clarification regarding billing for SBRT when two sites are being treated. ASTRO’s SBRT guidance states that the CPT instructions for CPT code 77373 SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions include the possibility of treating multiple sites of disease in one treatment course. If the sum of the treatment days for all sites treated during a single course of SBRT exceeds five, CPT code 77373 should not be reported.

  4. When to use unlisted procedure CPT code 77399.

    Payers describe claims that include CPT code 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services, when other codes would be more appropriate. Practices should only report this code if no other code adequately describes the procedure or service that the physician provided. When billing this code, practices should be certain of the individual payer’s requirements for unlisted procedures.

    For example, the Centers for Medicare and Medicaid Services Medicare Claims Processing Manual states that when reporting an unlisted procedure, practices should “include a description in item 19 if a coherent description can be given within the confines of that box.  Otherwise, an attachment shall be submitted with the claim.” (Chapter 26, page 16.)

We hope this guidance helps radiation oncology practices as they navigate potential billing issues. If you have billing questions or any other common billing pitfalls, let us know in the comment section, below.

To purchase the 2020 ASTRO Coding Resource, which includes information on updated CPT codes effective January 1, 2020, please visit our website. Or, if you’ve already purchased the Resource, you may access it by logging in to your MyASTRO account and clicking on Virtual Meetings/Products under “My Resources.”

Posted: February 18, 2020 | with 0 comments
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