Wiki Rad/Onc codes 77338 vs. 77334

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Our office is billing IMRT MCL 77338 to Medicare and 77334 to all other carriers. (No one in the office knows why they are billing this way, they were told to do this by a biller not working here any longer) I do not understand why? Any ideas?
 
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Local LCD's for Medicare specifically mention 77338 for IMRT. But, commercial payors have not indicated that 77338 is to be used only for IMRT. 77334 i think pays more (7 X 150= $1050, prostate) versus 77338 which comes back to only $497. So money/reimbursemnt/lack of IMRT policies by commercial payors is probably the reason.

Hope this helps.
 
My understanding on this is; The MLC's 77338 are only billable with use of the IMRT plan as more standard treatments do not use the multi lead collimator ( unless forward planning is used and then this is still a 3d plan not IMRT), also the CPT book inditates for IMRT treatments use 77338. For Idose, electron or 3d plans/treatments the 77332-77334 should be used for any imobilization devices or custom blocking.
 
You should stay consistent throughout the course of treatment. If you plan IMRT (77301), you should be treating with IMRT (77418) and should use an IMRT device (77338). The reason that IMRT devices are reimbursed so low is because most hospitals had such a low billed amount of them that the insurance companies didn't believe that they were worth much. When we recommend to our clients is the increase your billed amount to try to convince the payors that this is a much more difficult code. A typical plan of IMRT technically utilizes around 9 IMRT devices so your billed amount should be what you get paid for one times 9. i.e. $497.00 x 9 = $4473.00
If enough hospitals do this, we may actually get somewhere.

Alanna M Stuart BS RT(R)(T), CPC, ROCC, CHONC
Medical Billing Coder/Auditor
Physicians Management Services of Iowa
315 Walnut Street
Atlantic, IA 50022
712-243-7030
astuart@pmsia.com
 
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