Wiki 2015 Radiation Oncology CPT Changes

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daragan

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I am still new to coding and billing Radiation Oncology. I bill the professional portion of facility charges. For 2015 I have seen one source telling me I still will bill 77014-26 while another says 77387-26. All the 2015 changes seem confusing with the bundling/packaging of codes. Can someone clarify for me?
Thank you.
ADC
 
Medicare did not accept all of the coding changes for 2015 by the AMA so they adopted G-codes and are still using others for 2015. This is for Medicare, your commercial payors may vary. For physicians since 77014 was not deleted and 77387 is not used in 2015 by physicians for Medicare when billing for CBCT at the time of daily treatment they will still bill 77014-26. For commercial payors you may be using 77387-26 or 77014-26, you will need to contact them to find out.
 
More RadOnc questions

My office met for a meeting to update our RadOnc billing. There is some question as to whether the Basic Dos Calc code 77300 is being deleted or not. We understand these calculations are being bundled into the new Isodose code and Brachytherapy code but can we still use it for the straight 3D plan charges.
Isodose plans are going from simple, intermediate, and complex to simple and complex. Our take on this is that the intemediate will be bundled with the complex. How are people deciding how many calcs to bill with this new code?
And are there any changes to the device codes? I don't seem to see any.
 
Hello,
Code 77300 was not deleted. As you stated it is bundled into the new standard and brachytherapy isodose plans. It is still billable with 77295 and 77301, per the AMA CPT Manual it is not billable in conjunction with 77321.

The intermediate was rarely if ever supported anymore with technology. The utilization decreased so much the reimbursement tanked and it was not a shock nor will it be missed since it was rarely supported. The only two plans really used were the simple and complex isodose plans. Since the calculations are bundled into 77306 and 77307 (plus the brachy ones) you cannot bill any MU calculations when these treatment planning codes are billed.

No changes to the device codes.

Thanks.
 
I'm so glad you understand this. We had very little preparation on this an are trying to formulate a provider billing sheet to use.
Thank you again.
 
Hdr brachytherapy

I am in an outpatient hospital radiation oncology biller. I have some question:
When we do HDR Brachy cases in our department we use the Remote Afterloading HDR with the channels to deliver the source.
We normally bill out the initial plan as 77295 along with the 77300, we then will bill out the 77300 one time a day with treatment for the verification of decay (source strength). Should we bill out 1 dose calc (77300 x1) for every channel with the plan? We have not been billing out the dose calc on the first day if the plan was done the day before because there really is no decay.... the dose calc is still done but there is no change; should we still be billing it out?
It has been my experience that when talking to the staff sometimes they under estimate the work they do because they do it often. I just want to make sure we are doing it correctly.

Thank you!
 
Not every HDR plan will be 3D, there are some scenarios where it is very difficult to meet the criteria for 77295. For those that do, the initial decay factor calculation (77300) can be billed as this is not bundled into 77295. Only one decay factor calc can be billed, not for each channel. A decay factor calculation prior to each fraction is billable. Point dose calculations for any HDR are not separately billable.

For those courses where 3D is not supported and the new brachy isodose planning codes are appropriate (77316, 77317 and 77318) the decay factor calculation on the date of the plan is bundled. The subsequent decay factor calculations (one prior to each fraction to determine the source strength) would be billable. Point dose calculations for any HDR are not separately billable.

Documentation of the actual calculation is needed, even if handwritten.
 
Gyne HDR

Sorry about that last post, I was on 2014 billing!
Since you are so good at this I wanted to know if you could help me with another question(s)....
Question: on Gyne HDR Cylinders... I was told the hospital can bill the Vaginal balloon that is filled with Contrast for the CT done for the brachy plan.
We have not charged it in the past. Can we bill out the supply code for the Vaginal balloon and the contrast used or is that part of the 77290-TC or the brachy plan or the procedure itself?
We are an out-patient hospital radiation oncology department in IL.

Totally off topic but if we do a CT scan for a 3-D prostate patient but an anal balloon is filled with a contrast first and the anal balloon with the same set-up is used for every treatment can the hospital bill a supply code for the anal balloon or is that included in the one time charge of the 77290-TC? We have not been billing out for these two devices and I been told these are expensive devices we can bill out for to get some of our money back.
 
Hyperbaric Oxygen Therapy coding for late effects of radiation

Is there anyone that does the coding for HBO. Because insurance only pays for specific ICD-9 as Primary, and 1 of them is for late effects of radiation 909.2.

The patient is recieving HBO tx for the late effects of radiation so with this being the only reason they qualify for HBO 909.2 and it caused the residual condition with a leg ulcer.707.1X.

What would be the proper coding sequence since medicare will not pay for HBO with the ulcer as a primary.
 
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