Wiki Cpt 77014 vs cpt 77387 for 2015

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zaidaaquino

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I am seeing several denials from one of our commercial payers when billing CPT 77387 -26 for Place of Service 11 (office). From what I have found, CPT 77387 is a hospital code, correct? If so, would the correct code to bill for POS 11 be CPT 77014? (We're also billing with G6015 which has been paid). Any assistance is appreciated. Thanks.

Zaida
 
Due to the changes for 2015 and CMS not accepting all of the AMA coding changes you will need to reach out to each commercial payor to determine which set of codes they are accepting. If they are accepting the CMS G-codes for treatment, it is likely then for the IGRT you will need to report those G-codes and 77014 for CBCT. ASTRO has a tracker on their website of payors they have contacted and which set of codes they have indicated they are accepting.
 
It depends on the payor. HOPPS (Medicare for hospital based systems) accepted all new CPT codes by AMA for 2015, so 77387 is used by the hospital for IGRT, but only billable for 3D courses, not IMRT. Commercial payors may also elect to accept the 77387 for freestanding and physicians (even those in the hospital) for IGRT even though MPFS (Medicare for physicians and FSCs) did not. That would mean that particular payor is not accepting the G-codes created by CMS and is accepting the AMA CPT codes. To say it is an hospital only code is not the best way to state it.
 
77387 vs G code

I am so confused- we are hospital based-so I have been using the 77387-going by ASTRO, I only use the G code for Medicare patients-we are getting a ton of denials-especially from Aetna-but it states on ASTRO-g codes from free-standing clinics and 77387 from hospital based. I need to have some kind of answer because the denials are out of hand at this point. Thanks!
 
Since you are in a hospital you will follow the AMA codes for Medicare patients for the technical services. Your IGRT code is 77387 for the technical component billed by the hospital. If you are billing for the treatment planning CT at time of simulation, you will bill 77014-TC which you were doing in 2014.

Billing for the physician and their professional component is very different than the technical components in the hospital. For IGRT you will bill G6002-26 for stereoscopic guidance, 77014-26 for CBCT, G6017 for gating or G6001-26 for US. You will only bill 77387 to commercial payors if they are denying or not accepting the G-codes I just listed. The context for some of the indicators from ASTRO is not very clear.

I hope this makes a bit more sense.
 
77387

That does make some more sense-I have to read it again- I bill on the physician side-so I will take notes on what you have told me, thank you so much for your help-this has turned into a big issue.
 
I tried to email you more in the email I got from you but it came back as undeliverable. Here is what I was sending you.

Hello,
I listed your question below for reference.

From your previous post are you saying that 77387 can be used for 3-D only, not IMRT. If it is IMRT then we use the G code? Appreciate any feedback, I had a feeling that this was going to happen :)

No, for hospitals which are using codes 77385 and 77386 for IMRT the definition of the codes state they include image guidance so you cannot bill for any IGRT performed with any IMRT treatment. You can capture it with a dummy code to track the work, but you cannot bill for it. So you cannot report some other imaging code, you simply cannot bill for IGRT with IMRT. For a 3D course you can because the treatment codes do not include image guidance.

77385 - Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple
77386 - Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex

The physicians do not bill IMRT treatment codes, so they can bill for any IGRT that is supported by their work in reviewing and approving the image. Even though they are working in a hospital they will bill the G-codes or 77014-26 for CBCT (there is no G-code for this) unless a payor specifically tells you to bill 77387 for the IGRT, then you will bill that to the commercial payor who has chosen not to accept the G-codes which Medicare created and is accepting.

Thank you,
 
Help

Here is a sort of general question: for commercial payers (I know each may have their own rules), but in general, can modifier -26 be appended to CPT 77387 when the service is done at the doctor's office?
 
If the commercial payor has indicated they are accepting the CPT codes for IGRT and not the CMS created G-codes, which is outlined in MPFS final rule, then yes if billing the professional component the -26 would be applied to 77387.
 
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