Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 20, 2005 PDF

Bill for 0082T and 0083T on a per-day basis, not based on fractions

For years, radiation oncologists have been uncertain which code to bill for stereotactic neurosurgery of the spine. They could use CPT code 77432 for "gamma knife" surgery to treat cerebral lesions, but there wasn't any corresponding code for spine surgery.

However, since Oct. 1, 2004, you've had access to two new codes for stereotactic spine surgery, say coding experts. You can use the two new Category III codes for stereotactic body therapy - 0082T (Treatment delivery) and 0083T (Treatment management) - to bill for spine treatments, says Corinne Fisher, a coder at Yale University Medical Center. In the past, radiation oncologists had to use an unlisted code for spine treatments.

Just remember: The code descriptor for 0082T says you   can't bill for it with radiation   treatment delivery codes 77401-77416 or 77418. And you can't bill 0083T with radiation treatment  management codes 77427-77432, notes Fisher.

The new Category III codes have one major advantage over cerebral lesion code 77432, says Jim Hugh, vice president of American Medical Accounting and Consulting in Atlanta. Medicare pays for 0082T and 0083T on a per-day basis, whereas it pays for 77432 and 77427 based on treatment "fractions," Hugh notes. So far, carriers disagree on whether they'll cover the new Category III codes at all. National Heritage Insurance Co. says in a draft local coverage determination that it will automatically deny all claims for 0082T-0083T and other Category III codes as "investigational and experimental." But Wisconsin Physicians Service Insurance Corp. says it'll pay for 0083T and other category III codes on a case-by-case basis.

"Sometimes these Category III codes are just impossible to get paid," Fisher complains.

Obtaining payment for any new code can be tricky, but if you send in a report with the code and appeal any denials quickly, you should get paid, says Hugh. Payment may take a few months in some cases, but as long as you're not dealing with an unlisted code, you're likely to receive payment.