Oncology & Hematology Coding Alert

Question: We were denied for billing G6002 and 77412 with place of service (POS) code 22. The reason given is that the procedure code is inconsistent and needs to be submitted with a valid POS and that 77412 is already included in the visit. How should we resubmit?

AAPC Forum Participant

Answer: The first problem with your original claim is submitting 77412 (Radiation treatment delivery, >=1 MeV; complex) with POS 22 (On campus-outpatient hospital). The facility is the only entity that can bill this treatment code, and the provider should not bill that to a payer.

You can submit G6002 (Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy), on the other hand. However, this is the procedure that needs the modifier. As the facility will own the X-ray equipment required for the guidance, the correct modifier to use for the provider side would be modifier 26 (Professional component).

Remember: The image guidance must be ordered by the physician in the treatment planning document. The images must also be reviewed and approved before the next visit or you cannot bill for them. So, if the patient’s visit is on a Monday, and they return for their next treatment on a Tuesday, the provider must sign off on the Monday image before the patient’s Tuesday visit.

Last, instead of 77412, which is a treatment delivery code, you would then need to add a treatment management code to your claim. Assuming, for example, this is a course of five fractions, you would add 77427 (Radiation treatment management, 5 treatments) to the claim. Over a course five treatments, then, you would bill G6002-26 x 5 with 77427 after the final treatment.