Wiki Radiation Oncology Billing

Create Wiki
S

Sarah8307

Guest
Messages
12
Best answers
0
Any Rad Onc billers? I've seen post about helpful sheets that people requested. I am fairly new to rad onc billing and anything would be helpful.

Thanks
 
sls314 said:
If you're interested, there's a newer Facebook group for Radiation Oncology Coders and Billers. Someone there may have a cheat sheet to share. https://www.facebook.com/groups/radiationoncologycoders

Do you bill the professional or technical fees?
Click to expand...
Good morning! Thank you, I just requested to join! I manage a team that handles the professional fees. Primarily G6002-26 and 77014-26, UHC has been declining our codes as not authorized, and of course our code is different from the one on the hospital’s authorization. So, I am hoping to get a crosswalk that I can take back to our provider rep.
 
dschottler said:
Good morning! Thank you, I just requested to join! I manage a team that handles the professional fees. Primarily G6002-26 and 77014-26, UHC has been declining our codes as not authorized, and of course our code is different from the one on the hospital’s authorization. So, I am hoping to get a crosswalk that I can take back to our provider rep.
Click to expand...

The hospital should be including the image guidance codes for the physician on their authorization. What code is the hospital using on the authorization instead?

Edit to add: I support physicians at a few different, unrelated facilities, and all of my facility auth people include the image guidance on the auth.
 
Last edited:
dschottler said:
In some cases, though not all, they are authorizing 77387. Which best I can tell is correct for professional codes G6002-26 and 77014-26.
Here is a site that I previously found on Astro about it and it appears to be from the 2015 cpt guidelines. I can not find anything more current.
https://www.astro.org/Daily-Practice/Coding/Coding-Guidance/Coding-FAQ-39;s-and-Tips/FAQ-IGRT#:~:text=IMRT Delivery With IGRT&text=IMRT code: G6015 or G6016,CPT codes: 77385 or 77386
Click to expand...

The guidelines haven't really changed much in recent years, so the links on ASTRO are still current. (See my note below about the freestanding column though.) Do you have a copy of the current ASTRO guide or the Navigator for Radiation Oncology? Those books are great resources that spell out the whole cycle for treatment delivery.

It makes sense that the facility isn't authorizing 77387 every time, because not every treatment plan will include imaging guidance. The physician needs to specifically request imaging guidance in the treatment plan. Are you billing the imaging guidance for every patient, or just the ones where it was ordered/documented in the treatment plan?

Also for IMRT, the facility never bills for imaging guidance. The guidance is bundled into the facility code for IMRT delivery. (77385 or 77386) The provider can still bill the professional component for IMRT image guidance.

77014 is for the cone based CT. G6002 is for the stereotactic x-ray. The code you'd use depends on which one was performed - an x-ray or a CBCT. Those 2 codes aren't interchangeable. (Even though some payors don't seem to understand that at times.)

BTW - on the link you shared, the left column for Free Standing is not applicable to you since your services are being provided in a hospital setting. Freestanding in the context of radiation oncology means a provider owned center that has no hospital affiliation. The physician bills for the entire service, including all the radiation materials. (For example, my center isn't located on hospital property, but it is still owned by the hospital. I still code/bill as a hospital based center - it's not freestanding just because it is in a standalone building.)
 
Last edited:
sls314 said:
The guidelines haven't really changed much in recent years, so the links on ASTRO are still current. (See my note below about the freestanding column though.) Do you have a copy of the current ASTRO guide or the Navigator for Radiation Oncology? Those books are great resources that spell out the whole cycle for treatment delivery.

It makes sense that the facility isn't authorizing 77387 every time, because not every treatment plan will include imaging guidance. The physician needs to specifically request imaging guidance in the treatment plan. Are you billing the imaging guidance for every patient, or just the ones where it was ordered/documented in the treatment plan?

Also for IMRT, the facility never bills for imaging guidance. The guidance is bundled into the facility code for IMRT delivery. (77385 or 77386) The provider can still bill the professional component for IMRT image guidance.

77014 is for the cone based CT. G6002 is for the stereotactic x-ray. The code you'd use depends on which one was performed - an x-ray or a CBCT. Those 2 codes aren't interchangeable. (Even though some payors don't seem to understand that at times.)

BTW - on the link you shared, the left column for Free Standing is not applicable to you since your services are being provided in a hospital setting. Freestanding in the context of radiation oncology means a provider owned center that has no hospital affiliation. The physician bills for the entire service, including all the radiation materials. (For example, my center isn't located on hospital property, but it is still owned by the hospital. I still code/bill as a hospital based center - it's not freestanding just because it is in a standalone building.)
Click to expand...
I am in the middle of a debate where I work. My IMRT treatments are getting denied because the therapists and providers keep charging 77014 with them for the cone-beam CT. Can we bill JUST the professional component of 77014 with IMRT? I'm still relatively new at this, but I think we have a fatal flaw in using IGRT and CBCT interchangeably.
 
abarber82777@gmail.com said:
I am in the middle of a debate where I work. My IMRT treatments are getting denied because the therapists and providers keep charging 77014 with them for the cone-beam CT. Can we bill JUST the professional component of 77014 with IMRT? I'm still relatively new at this, but I think we have a fatal flaw in using IGRT and CBCT interchangeably.
Click to expand...

Yes. You can bill the professional component of 77014 with IMRT. The facility cannot bill the technical component, because it is bundled with the 77385 and 77386 CPT codes.

The ASTRO website has some great coding guidance, including a chart which shows when IGRT can be billed. You can find it on this link:

 
You must log in or register to reply here.
Top