Wiki Medicare Audit of CPT 77014 for Radiation Oncology

[christiwithani]

The local MAC has requested documentation for the payment review of 77014 on a number of our patients. According to the contact person I have been working with, I am not sending in the correct documentation. Has anyone ever gone through a review of this code before? I have sent in so much information already, I don't have anything left to submit!

 

[sls314]

The local MAC has requested documentation for the payment review of 77014 on a number of our patients. According to the contact person I have been working with, I am not sending in the correct documentation. Has anyone ever gone through a review of this code before? I have sent in so much information already, I don't have anything left to submit!

There was recently a False Claims Act settlement of $800,000 where 2 radiation oncology practices in New York billed for IGRT when the images weren't reviewed and approved timely. I would guess that's why IGRT is on CMS's radar.

Here's a link to the Justice Department website regarding False Claims Act settlement for IGRT: https://www.justice.gov/usao-edny/p...over-800000-settle-claims-physician-practices

If I were pulling information for an IGRT audit, I'd send the Treatment Plan document showing that daily IGRT was ordered by the physician. Then I'd also send documentation showing that the images and shifts were reviewed and approved by the radiation oncologist prior to the patient's next treatment.

The physician must sign off on the daily IGRT before the patient's next treatment, or you can't bill for it. (Ex - if the patient has a treatment scheduled for Monday and Tuesday, the physician must sign off on the Monday images before the Tuesday treatment, or you can't bill for Monday's IGRT.)

If you have any other questions, please let me know!