Wiki Meaning and Example of the Fee Schedules 09-Concept doesn't appy

[mrosbun]

Hello,

I'm looking for clarification, meaning, and an example of the Fee Schedules Physician Supervision: 09-concept doesn't apply regarding Diagnostic services. I'm especially looking for clarification for the supervision requirements for cpt codes 77280-77290 (radiation oncology simulation codes). It is saying 09 for the global, TC, and 26.

I'd appreciate any help and expecially any references to be able to provide to my management team.

Thank you,
Ruby

 

[CBLENNIE]

Payment indicator 9-concept "xyz" does not apply is used in many fields, not just the PC/TC indicator field, it is used for other payment modification reasons such as bilateral and multiple procedures. The MLN Booklet How to Use the PFS Look-Up Tool linked here may help you show this to your management in the section titled Payment Policy Indicator Search on page 16.


Specific to PC/TC Indicator 9=Concept of a professional or technical component doesn’t apply, means that there is no situation where you might have a PC or TC for the specified diagnostic code. Check out pages 26 & 27 of the linked MLN Booklet for a full description of each of the indicator codes for the PC/TC Indicator field.

If you look at pages 27 & 28 under the Multiple Procedure (CPT Modifier 51) you will find that at the end of the list of indicator codes that 9-Concept doesn't apply. I am pointing this out to show that the payment indicator 9 is used for multiple types of payment modifications.

When I use the PFS look up tool for 2024 I show CPT 77280 has a PC/TC Indicator of 1, here is a snip of the search I did for 77280, which I limited my search to payment policy indicators.


Where did you find that the payment policy indicator 9 is applicable to 77280 for the PC/TC indicator?

 

[sls314]

Hello,

I'm looking for clarification, meaning, and an example of the Fee Schedules Physician Supervision: 09-concept doesn't apply regarding Diagnostic services. I'm especially looking for clarification for the supervision requirements for cpt codes 77280-77290 (radiation oncology simulation codes). It is saying 09 for the global, TC, and 26.

I'd appreciate any help and expecially any references to be able to provide to my management team.

Thank you,
Ruby

The fee schedule isn't the place you'd look to find information about the supervision requirements for simulations. Look to your resources from ASTRO. The ASTRO website has a lot of coding guidance publicly available. https://www.astro.org/Daily-Practice/Coding/Coding-Guidance

ASTRO also publishes the annual Radiation Oncology Coding Resource, which is the gold standard for coding and documentation requirements. If a practice codes and bills for radiation oncology, it should have access to a copy of that information.

You can also find good information and training on Radiation Oncology from RCCS and AMAC. Both offer webinars specific to radiation oncology.

RCCS publishes Navigator for Radiation Oncology, which is another great reference book: https://store.rccsinc.com/collectio...*1nml6jr*_gcl_au*MTEwMDUwNDUxNy4xNzA1NzA3MDkx

AMAC maintains the ROCC (Radiation Oncology Certified Coder) program and has a lot of resources on its website: https://amac-usa.com/


Also, I have a Facebook group for Radiation Oncology Coders & Billers. You're welcome to join and ask any specific questions about documentation there, too: https://www.facebook.com/groups/radiationoncologycoders

 

[sls314]

What type of practice setting do you work in? The supervision requirements are different for Hospital Outpatient Department and Freestanding.

You can read more on the ASTRO website - enter "supervision" in the search bar, and it will take you to an ASTRO white paper on supervision requirements.