Wiki Radiation IMRT plan

[MichelleMcShane]

I would like to pose the question of billing the initial SIM 77290. can we bill this before the IMRT Plan code is billed 77301. We tend to SIM the patient and figure out a plan after the SIM is done. Can we still bill for this SIM? There isn't a Medicare policy in our area for this and I haven't seen any denials yet there are conflicting statements out on the web regarding this issue.

 

[astuart@pmsia.com]

As I'm sure you know, ASTRO recently came out with the "recommendation" that the initial simulation was included in the IMRT planning process even when performed on different date of service. This whole issue came up many years ago when CMS made the same statement but retracted it a few months later stating that it was a mistype and that they are only not allowed on the same date of service. As of now, no one really knows where ASTRO came up with this recommendation and they have not given any explanation themselves. There are many smaller and national organizations fighting this right now as it really doesn't make sense. Of all the forms of radiation, IMRT is the one that needs the most preplanning and reproducibility.

That being said, it all comes down to the policies. Currently we have not come across any policies, Medicare or Commercial, that are showing this. My suggestion is to continue billing it until the policies change.

Although ASTRO has always been a wonderful resource, they only provide recommendation. It is up to the insurance companies to determine if they decide to follow these recommendation.

I hope this helps,
Alanna M Stuart BS RT(R)(T), CPC, ROCC, CHONC
Administrative Director
Physicians Management Services of Iowa
1097 Longfellow Dr.
Hiawatha, IA 52233
319-286-3763
astuart@pmsia.com

 

[MichelleMcShane]

Thank you it does shed some light on the issue. I've never had a denial on this issue yet we are getting push back from some admin people in clinic, yet there isn't solid proof to back anything up. So thank you!