Oncology & Hematology Coding Alert

But you can use modifiers to separate these oncology-related edits

Radiation oncology coders who report new codes G0338-G0340 with basic dosimetry calculations should now append a modifier to 77300 to ensure accurate coding and to prevent denials.

Thanks to version 10.2 of the National Correct Coding Initiative (NCCI), Medicare and other payers will deny your 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) claims if you bill them with the new G  codes for robotic stereotactic radiosurgery without appending a modifier.

Bundling G0338 with 77300 and other radiation oncology codes (77290, 77295, 77321, 77336 and 77370) is a logical edit, says James E. Hugh III, MHA, ROCC, senior vice president of American Medical Accounting & Consulting in Atlanta. That's because NCCI already bundled these same radiation codes with G0242 (Multi-source photon stereotactic radiosurgery [cobalt 60 multi-source converging beams] plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment) years ago.

CMS introduced codes G0338-G0340 for 2004 because there were no codes that denoted stereotactic radiosurgery using a linear accelerator, as opposed to cobalt 60-based SRS (covered by codes G0242-G0243). Medicare reimburses roughly $1,450 for G0338 (planning), $5,250 for G0339 (first session or single-session treatment) and $3,750 for G0340 (second through fifth sessions).

And remember: Coding regulations allow only hospitals to report G0242-G0243 and G0338-G0340, not freestanding centers, Hugh says. Learn Other Radiation Oncology Edits NCCI 10.2 institutes dozens of radiation oncology edits, including one that bundles G0338-G0340 (... stereotactic radiosurgery...) into 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session). Because this edit features a "0" indicator, no modifiers can separate the edit. "A daily intensity modulated radiation treatment (IMRT) would not be expected on the same day as the stereotactic radiosurgery (SRS) codes," says Deborah Churchill, RTT, president of Churchill Consulting Inc., a medical reimbursement consulting firm in Killingworth, Conn. "Therefore, it is appropriate that 77418 and G0340 cannot be reported on the same day."

NCCI also bundles the following radiation oncology codes into G0338-G0340:

77280-77290 - Therapeutic radiology simulation-aided field setting .... Insurers only bundle these codes when you perform the simulations the same day that you report G0338-G0340.

77295 - Therapeutic radiology simulation-aided field setting; three-dimensional. You should report either SRS or 77295, but never both services.

77300 - Basic radiation dosimetry calculation ...

77305-77321 - Teletherapy, isodose plan [...]