Wiki Radiation Therapy - HELP!!


Pulaski, WI
Best answers
I work at an insurance company & I have a provider that keeps submitting CPT 77413 with CPT 77418. Our coding program (iCES) denies CPT 77413 as unbundled from CPT 77418. According to CCI, this denial is correct. Per CCI, CPT 77413 is NOT allowable with CPT 77418 & modifier -59 is NOT allowed. The provider's office insists they are billing correctly. They state that CPT 77418 is for the IMRT delivery to the left breast (the PT has breast ca) & CPT 77413 is for the "boost" (7 fractions) to the tumor bed. The records DO support that they performed IMRT AND a "boost" to the tumor bed. Radiation therapy coding is not my strong suit. Can anyone help me? Should they be reporting a different code for the "boost"? Or is a "boost" inclusive in the IMRT? I really don't know what to tell them except that CCI doesn't allow this code combination. Any help is very much appreciated!!

You are correct 77413 is the delivery code for 3D conformal, 77418 is the delivery code for IMRT the boost is included in each delivery code.
Thank you LaDonna. So if the boost is included in the IMRT delivery (CPT 77418), then they shouldn't be reporting CPT 77413 for the boost, correct? Thanks again.