Radiology Coding Alert

NCCI 10.2 bundles scores of radiation oncology codes together, but modifiers can separate many new edits If your hospital routinely reports the new radiation oncology codes G0338-G0340 with basic dosimetry calculations, prepare yourself for an approximately $100 pay cut unless you append a modifier to 77300.

Thanks to version 10.2 of the National Correct Coding Initiative (NCCI), Medicare and other payers will deny your claims for 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) if you bill them with the new G codes for robotic stereotactic radiosurgery without appending a modifier. Several Edits Target G0338-G0340 NCCI Edits 10.2, effective through Sept. 1, 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 ... 77305-77328 -- Radiation oncology codes including teletherapy and isodose planning. Insurers always include these services in 3-D and SRS plans. 77332-77416 - Radiation physics, treatment delivery codes 77432 - Stereotactic radiation treatment management of cerebral lesion(s) (complete course of treatment consisting of one session). NCCI Bundles J2001 Into Hundreds of Codes If your practice reports J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) for lidocaine when you perform spinal injections, hyperthermia or thrombin injections, expect a flood of denials starting July 1. Although most payers already bundled lidocaine payment into your injection fees, a new NCCI edit confirms that you should never bill J2001 unless you treat a patient for cardiac arrhythmia. History: HCPCS Codes deleted J2000 (Injection, lidocaine Hcl, 50 cc) this year and introduced J2001 in its place. Although most radiology coders accurately took this as a sign that Medicare never intended [...]