Wiki Code 77470

Create Wiki
P

ptarver

New
Messages
2
Best answers
0
I am a biller with a facility that bills for a cancer center. I have been working Medicare HMO denials for code 77470. The claims have been billed with diagnosis codes V58.0, 174.9 and 162.9 but the Medicare HMO denied stating not an approved diagnosis. I need to appeal the claims. I was wondering if anyone could come up with a justification why this code would be denied?
 
I'm not an expert on this........but maybe it's because both codes used for the cancers are unspecified codes.

174.9 Breast (female), unspecified
162.9 Bronchus and lung, unspecified


There are other codes for both that give more specific locations. That could be what they want......but just a guess on my part....
 
Cpt 77470

Hi...

Please see the criteria of billing this code.may be works for you...
77470 Special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral or
endocavitary irradiation
A special treatment procedure may be utilized for circumstances that require extra and inordinate
amounts of time and effort by the staff and the physician, which is medically necessary for the patient and
not routine to the service being performed. The use of this procedure code would be appropriate when
the ?planned course of therapy? is considered above and beyond the standard for the service performed.
For example, routine IMRT or 3D conformal planning and treatment methods are not approved for a
special treatment procedure; however, patient circumstances requiring additional planning or treatment
time, in addition to a routine 3D or IMRT course of therapy, may qualify. Another example is concurrent
chemotherapy. If a chemotherapy regimen requires the radiation oncologist to take this information into
account when prescribing radiation, then the additional consideration might be considered above and
beyond the standard of care.
It is not appropriate for this code to be billed when a patient has another ongoing medical diagnosis such
as diabetes, COPD or hypertension, which is unrelated to the treatment of cancer.
Standards for CPT? 77470
? Special treatment procedure (CPT? 77470) must be requested by the provider.
? Maximum quantity of special treatment procedures (CPT? 77470) allowed per course of treatment
is one (1).
? When requested in conjunction with stereotactic radiotherapy, brachytherapy or concurrent
chemotherapy, one (1) special treatment procedure (CPT? 77470) may be approved.
? CPT? 77470 is NOT authorized for the sole use of 3D conformal therapy or IMRT. CPT? 77470
may be approved for circumstances above and beyond the routine planning and treatment of
these modalities.
? CPT? 77470 will not be routinely allowed merely for the receipt of concurrent chemotherapy but
instead be based upon documented medical necessity requiring extensive work on the part of the
physician and staff as a result of the chemotherapy in combination with radiation therapy
? When a special treatment procedure is requested with 2D, 3D or IMRT courses of therapy,
patient specific medical necessity rationale is required. CPT? 77470 may be approved if ALL of
the following criteria are met:
 
Hello,
Does the Special Txt have to be billed on the date of the MD plan or the Simulation? The note is located in the MD Plan under the Sim Setup
 
PEARSONS said:
Hello,
Does the Special Txt have to be billed on the date of the MD plan or the Simulation? The note is located in the MD Plan under the Sim Setup
Click to expand...
No, CPT 77470 is not date specific, but some payers require it be billed with the planning codes
 
ptarver said:
I am a biller with a facility that bills for a cancer center. I have been working Medicare HMO denials for code 77470. The claims have been billed with diagnosis codes V58.0, 174.9 and 162.9 but the Medicare HMO denied stating not an approved diagnosis. I need to appeal the claims. I was wondering if anyone could come up with a justification why this code would be denied?
Click to expand...
Medicare requires an actual cancer diagnosis if one is available, and the leading diagnosis code should be the Z51.0 encounter code for radiation therapy treatment. Because those diagnoses are "unspecified", you may want to query your provider to see if there is a more specific cancer diagnosis. But the medical records must support the medical necessity criteria for billing CPT 77470. Many Medicare MCO's also require this code be prior authorized too. Hope this helps
 
You must log in or register to reply here.
Top