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Billing 77338 and G6015/77385

C

cnalpe68@gmail.com

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2
Location
Bauxite, AR
The CPT book states you can’t bill 77338 and G6015/77385 out together on the same day and yet the admin of the our Radiation dept is insisting we do it anyway and use modifier XE or 59 on 77338. Is this something I should do?
 
What is the situation where you're billing 77338 with the treatment codes? Is it for a Boost Plan or View Ray? Per NCCI, you can bill 77338 with a 59 or XE, but I would need a little more context on the situation.

Hope this helps
 
It is for the Boost, then on the same date of service as the boost they are also doing a radiation treatment (77385 or if Medicare G6015). I don't understand why you can use any modifier if the CPT code book has a parenthetical under 77338 that states (Do not report 77338 in conjunction with 77385 for compensator based IMRT). Normally we bill the boost out with an XE, regardless of whether or not 77385 was also done on that same date of service, because it will get kicked based on the fact that you are not supposed to bill out 77338 more than once per treatment plan.

It's all very confusing to me! The parenthetical is even confusing because 77385 isn't even compensator based...77386 is. Also, when you look up 77385 shouldn't it have a parenthetical about using it with 77338? It doesn't, but 77386 does.
 
tammy.kirkpatrick said:
Hello, I am new to IMRT billing. Need help, We bill 77338-XU and G6015 and G6015 gets's denied stating procedure code incidental to the primary procedure.
Click to expand...

Welcome to IMRT billing.

How often is it coming up that you're billing 77338 on a treatment delivery day? Normally my 77338 goes out with the IMRT plan 77301, before the treatment begins. I'm just trying to clarify the scenario, so that I can give correct suggestions.

What type of facility are you billing for? (I'm guessing freestanding POS 11 based on the G6015, but just double checking.) Do you have access to any reference books (ex - the ASTRO book or RCCS Navigator for Radiation Oncology book)? If not, I'd highly recommend seeing if your employer will help you obtain one or both books.

Also, I have a Facebook group for Radiation Oncology Coders and Billers - you're welcome to join if you'd like. There are close to 300 rad onc coders/billers in the group, and many of them have a lot of experience. It's a good place to ask questions specific to rad onc. https://www.facebook.com/groups/radiationoncologycoders/
 
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