Oncology & Hematology Coding Alert

Question: If the patient requires both a mask (complex) and a bite block (intermediate), may I report the professional component for both of them?

Pennsylvania Subscriber

Answer: You should code only one restraining (immobilizing) device "for each volume of interest treated," according to Highmark Medicare local coverage determination L27515, "Radiation Therapy Services."

You should choose the higher-level code, which in this case is 77334 (Treatment devices, design and construction; complex [irregular blocks, special shields, compensators, wedges, molds, or casts]).

Note that Highmark allows you to report restraining devices and modification devices for the same port separately.

Highmark instructs providers to report devices at the beginning of treatment, but states you may report devices later if the patient requires additional devices during the course of treatment. Highmark may require documentation if you report more than eight units for treatment devices during the treatment course.

Requirement: To report the professional component (modifier 26, Professional component), "the physician must be directly involved in the design, selection, and placement of any of the devices," Highmark states.

For an immobilization device, the physician typically documents approval in the initial simulation note prior to patient treatment.