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demassd

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How does anyone get 77336 paid through Medicare? We have tried several ways to billbut they come back denied.


Thank you
 
demassd said:
How does anyone get 77336 paid through Medicare? We have tried several ways to billbut they come back denied.


Thank you
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Is the pt previously been billed for CPT 77301 for IMRT planning?


The current Medicare policy is that CPT 77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy may NOT be reported when the service is part of the IMRT planning process (CPT 77301).
CPT 77336 is appropriate for the “weekly” continuing medical physics process and reports the work and oversight of the medical physicist in the care of the patient.

Thanks
 
77336

You should be able to bill the 77336 every five fractions regardless of type of therapy. The restriction with the 77301 is that you need to prove that the physicist actually did the weekly physics check above and beyond the check of the 77301. They cannot use the same physics check for both. As long as you are not billing them on the same date of service, you should be getting reimbursed for it.
As far as when to bill it, the key is to bill it every 5 fractions not just once weekly. A lot of physicists get in the habit of billing it out on the same day each week (i.e. every Tuesday). This will result in denials. Also, it is one of the few codes that does not actually need to be billed on the same date of service that it was performed. As long as it has been performed within the 5 fractions, you can bill it out of whichever date you want.
Example: Patient is treated for 5 fractions, Tuesday - Monday, Physicist checks the chart on Thursday, you can bill out the 77336 on any of those days. Just be consistent. Bill it out of fraction 5, 10, 15, etc. or one fraction 3, 8, 13, etc.
Also be aware that if you do any additional dosimetry on that date of service, you will need a modifier on the 77336.
Hope this Helps

Alanna M Stuart BS RT(R)(T), CPC, ROCC, CHONC
 
77336

How do you decide which physician to use, when billing the 77336 in a group setting? is it the doctor who is the attending physician? What if the attending physician is out that week, and a different doctor is in charge of the patients care and is billing the 77427?
 
Sounds like you are asking about two different things. The 77336 is a technical-only code so you bill it under the supervising physician for the day if the center is freestanding, or you bill it without a physician ID if this is a hospital-based center. For the 77427, you bill the weekly management under the physician who performed the weekly face-to-face evaluation of the patient. Be careful about your dates of service, since this is where most errors are made. The f-2-f eval MUST take place within the five-fraction reporting period for each weekly management service charge. Some payors prefer to see that charged on day 1, day 6, day 11, and so on. Others prefer day 5, 10, 15, etc. So your f-2-f eval must take place once within the date range covered by each time you enter it. So for the first scenario, payor wants the service charged on day 1, day 6, etc.: there must be a visit between day 1 and day 5, another one between day 6 and day 10, etc. Having two visits in one 5-fraction range does NOT mean you get to charge two weekly evals., nor does it make up for a range where the visit was missed. Clear as mud? Hope this helps...contact me if you need more help, radiation oncology is my specialty!
 
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