Oncology & Hematology Coding Alert

Question: We billed one unit of 77290, 77318, and 77370, then billed again a week later and got denied. We appealed, but the payer said we had billed more units than allowed. What is the frequency of these billed services?

AAPC Forum Participant

Answer: The likely reasons for the denials are as follows:

• 77370 (Special medical radiation physics consultation) can only be billed once per episode of care. As you had already billed the week before, you cannot bill it again for the rest of that course of treatment.
• 77318 (Brachytherapy isodose plan; complex …) is also typically performed once for each brachytherapy applicator insertion procedure. If your provider performs multiple insertions, you may be able to bill for multiple isodose plans, but if the provider did not perform another isodose plan for your date of service (DOS), or if they did not document a plan, you won’t be able to bill for another one.
• Similarly, you won’t be able to bill a second 77290 (Therapeutic radiology simulation-aided field setting; complex) in that amount of time unless the provider performed and documented a new simulation.