Wiki Radiation treatment planning

[klbecker]

I have a Neurosurgeon that is starting to do therapeutic radiology treatment planning with a Radiation Oncologist. They are not in the same group. My doctor told me he will only be doing the planning, reviewing the tests and discussing the best treatment method, approach, etc. He will not be seeing the patient. I found CPT code 77263. The Oncologist office coder told me my surgeon should bill 67196. That is the code the company, who's machine they will be using, told her. They would bill the 77263. My doctor will not be doing any Stereotactic Radiosurgery. I don't agree with my doctor billing the 67196. To me that is not what he is doing.

Has any one else come across a situation like this? Any input and advice is GREATLY appreciated. This is something new to me

Thank you
Kristy

 

[fredabrinson]

Some Info

Hey Kristy,

I found your post while I was reviewing this very same issue! I don't know if you are still looking for the answer to this, but I'll go ahead and share what I was able to find.

I started with the CPT subsection guidelines for 61796 code series, and those guidelines do state that the neurosurgeon bills this series for his/her services. I also found this same info in several other professional sites.

But the issue of the neurosurgeon not being present at the radiation delivery was not addressed. I looked through the NCDs and still nothing. Then, but the grace of God, I looked in my state's LCDs. And I found the answer!!

Per Georgia LCD #L34283, if the neurosurgeon is not present during any of the services involved with CPT code 61796-61799, use modifier 52, 54,55 or 56.

I hope this helps you if you were still needing the info!

Good luck!