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Wiki 77387-26 - BCBS - imaging codes Radiation Oncology

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sherri.beegle@peachtreeradonc.com

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Can anyone provide insight into BCBS/Anthem imaging billing and whether they prefer 77016, G6002, or 77387-26? We have been submitting 77387-26 based on what we thought, but they are paying the billed amount and we can't seem to get answers.
 
77387 is a hospital only code, with the exception of Aetna wanting it reported for office/freestanding clinic also. We report G6002 in most cases, for freestanding for all other payers.
 
kathleeng said:
77387 is a hospital only code, with the exception of Aetna wanting it reported for office/freestanding clinic also. We report G6002 in most cases, for freestanding for all other payers.
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Follow-up question on this... in relation to UHC. Our G6002-26's are all being denied as no auth. I can see that the hospital is getting auths based on the hospital code sets; which are different from ours. Do you know where I can find an updated hospital code to professional code crosswalk?
 
dschottler said:
Follow-up question on this... in relation to UHC. Our G6002-26's are all being denied as no auth. I can see that the hospital is getting auths based on the hospital code sets; which are different from ours. Do you know where I can find an updated hospital code to professional code crosswalk?
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You should be able to use the hospital's authorization number. I code and bill radiation oncology, and I always use the facility auth number.

The hospital services are different from the professional services - the codes aren't equivalent, and there isn't really a crosswalk. Other than the handful of global codes that have a professional/technical component.

Do you have a copy of the ASTRO manual? There's a lot of good information in there. Also RCCS puts out a book titled Navigator for Radiation Oncology. You can also find a lot of good resources on the ASTRO website and through AMAC,
 
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