Wiki 77300 x 13, 77334 x 13 Radiation Oncology Number of units question

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sidney01@roadrunner.com

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I have received an SS edit. Billing THINKS it is because of the number of units we have billed. From everything I can find, the number of units should not be a problem. Does anyone know about this? The MUE edit is showing max of 10. Do I use second line with modifier 76 for the additional 3? This is for set up/planning for brain cancer. The edit states, "If a charge level adjudication record exist then each charge line must have charge level adjudication, or the records must be deleted". Please advise. Thank you!
 
sidney01@roadrunner.com said:
I have received an SS edit. Billing THINKS it is because of the number of units we have billed. From everything I can find, the number of units should not be a problem. Does anyone know about this? The MUE edit is showing max of 10. Do I use second line with modifier 76 for the additional 3? This is for set up/planning for brain cancer. The edit states, "If a charge level adjudication record exist then each charge line must have charge level adjudication, or the records must be deleted". Please advise. Thank you!
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77300 and 77334 do have an MUE value of 10. It's a MAI indicator of 3 (per day edits based on clinical benchmarks), so you can appeal with documentation. You can look in this document for processing and appeal instructions for that type of MUE edit: https://www.cms.gov/files/document/...edically-unlikely-edit-mue-program-mm8853.pdf

That's assuming that the documentation supports 13 units of each code.

Were there 13 billable complex treatment devices documented and supported? That seems unusual to me. (I'm not saying it couldn't happen, I suppose, but I'd definitely be analyzing the documentation.)

I code and bill professional fees for Radiation Oncology.
 
The ASTRO website is a good resource for coding guidance. This is from the ASTRO Coding Guidance and FAQ section. (You didn't mention the treatment type, but I'm including the question and ASTRO link in case the treatment was delivered with a Cobalt 60 system.)


Coding Question: With the new rotating multisource Cobalt 60 system, the number of shots for a treatment may exceed 10. Each shot will include a combination of various collimators. Would you follow the rule of one device per shot not to exceed 10, or would you have a different recommendation in determining the quantity of devices to be reported?

Coding Answer: For the billing of devices (CPT code 77374), it is recommended to bill for one device per collimator per episode of care. The maximum of 10 units applies to CPT code 77300 (basic radiation dosimetry calculation).
 
Hello, I'm a fairly new coder for an RCM company and I have recently been assigned a nuclear medicine client. I was hoping to get some credible resources where I may find it stated exactly how to bill units for 77300 for RPT. For external beam, it seems to be billed 1 units per arc/beam, but for RPT I cannot find a statement anywhere that corroborates my physician's statement that 77300 should be billed per region of treatment.

The typical documentation will state "The prescribed dose of Lu-177 was chosen based on the results of the [...] trial. Models suggest this results in [range] Gy of radiation to the kidneys and [range] Gy to somatostatin expressing tumors." The physician also states that they have always previously billed 9 units for 77300 based on the treatment regions whole body, tumors, submandibular gland, parotid gland, left kidney, right kidney, liver, spleen, and one other region of which I am unsure. However, as seen in the documentation above, the only regions addressed are the tumor(s) and the right and left kidney.

I have read through the billing strategies (https://rrp.cancer.gov/working_groups/20200123_Graves_RPT-Billing.pdf) and reimbursement approaches (https://jnm.snmjournals.org/content/62/Supplement_3/48S) for RPT but it is very dense for a non-specialist coder to parse, and I do not seem to find how many units are being billed per 77300. Although both sources listed above are credible for their medicine, I have noted that they are not authored by credentialed coders/billers, a note that the author themselves make at one point.

TLDR: can anyone link me to a reputable coding source where it is stated how to bill units of 77300 specifically for RPT?

Thank you!
 
cainneigh said:
Hello, I'm a fairly new coder for an RCM company and I have recently been assigned a nuclear medicine client. I was hoping to get some credible resources where I may find it stated exactly how to bill units for 77300 for RPT. For external beam, it seems to be billed 1 units per arc/beam, but for RPT I cannot find a statement anywhere that corroborates my physician's statement that 77300 should be billed per region of treatment.

The typical documentation will state "The prescribed dose of Lu-177 was chosen based on the results of the [...] trial. Models suggest this results in [range] Gy of radiation to the kidneys and [range] Gy to somatostatin expressing tumors." The physician also states that they have always previously billed 9 units for 77300 based on the treatment regions whole body, tumors, submandibular gland, parotid gland, left kidney, right kidney, liver, spleen, and one other region of which I am unsure. However, as seen in the documentation above, the only regions addressed are the tumor(s) and the right and left kidney.

I have read through the billing strategies (https://rrp.cancer.gov/working_groups/20200123_Graves_RPT-Billing.pdf) and reimbursement approaches (https://jnm.snmjournals.org/content/62/Supplement_3/48S) for RPT but it is very dense for a non-specialist coder to parse, and I do not seem to find how many units are being billed per 77300. Although both sources listed above are credible for their medicine, I have noted that they are not authored by credentialed coders/billers, a note that the author themselves make at one point.

TLDR: can anyone link me to a reputable coding source where it is stated how to bill units of 77300 specifically for RPT?

Thank you!
Click to expand...

ASTRO resources are the official source for radiation oncology. In the 2024 Radiation Oncology Resource book, Chapter 20 covers Therapeutic Radiopharmaceuticals, Radioimmunotherapy, and Microsphere Radiotherapy.

You can find more information about the book and other ASTRO coding resources here: https://www.astro.org/Daily-Practice/Coding

RCCS is another great source for radiation oncology and training. They publish the Navigator for Radiation Oncology books and also offer some courses and webinars. I'm a big fan of their materials and have used some myself. They have an entire Radiation Oncology curriculum, which is also broken down into modules that you can take individually.

One of the modules of the Radiation Oncology curriculum that can be purchased separately is on Radiopharmaceutical Procedures. Here's more information about that if your employer would be willing to purchase it for you. (The module is only $99 and it is approved for 1.5 CEUs. It might be a reasonable investment for your employer.) https://store.rccsinc.com/products/ro7-radiopharmaceutical-procedures

AMAC is another great source for Radiation Oncology information and education. That's the organization that maintains the ROCC credential (Radiation Oncology Certified Coder) that I hold. You can look under the Education tab on their website to see all of their offerings: https://amac-usa.com/

Last but not least, I have a Facebook group for Radiation Oncology Coders and Billers. You're welcome to join if you want - there are 400+ members in the group. I don't code radiopharmaceuticals in my current position, but most likely someone in the Facebook group does: https://www.facebook.com/groups/1321725581902420
 
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