Wiki Radiation treatments (77402)

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CoderinJax

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I need some help in re: to a few records that I'm looking at for one of our Dr's. He's a Dermatologist that also treats BCC's and SCC's. (Hemat/Onc coding is a new specialty for me.)

We have a patient that has SCC in 4 different sites (LT hand-2nd digit, LT hand dorsal, LT wrist, and LT lateral wrist) and comes in and has treatment on these 4 places on the same date.

We are billing CPT 77402 with 8 Units (UOS), because our Dr. is doing each site 2x (2 Fx's I think it's called?), 90kv is the modality, FX dose is 130, so the daily dose is 260 per site.

I've read the description of CPT 77402 and it says SINGLE treatment area, and I think that CPT 77412 might be better since it says "3 or more treatment areas". I'm confused as to why our Dr would be selecting 77402 vs. 77412. Anyone have ideas? I'm sure I'm missing something since this is new to me!
 
I do agree with you that it should be the 77412 however, this can only be billed once per fraction no matter how many sites are being treated and typically only once per day. If the patient is truly having BID treatments (separated by at least 6 hours) than you can bill a second 77412 with a -59 modifier.
Hope this helps!
 
astuart@pmsia.com said:
I do agree with you that it should be the 77412 however, this can only be billed once per fraction no matter how many sites are being treated and typically only once per day. If the patient is truly having BID treatments (separated by at least 6 hours) than you can bill a second 77412 with a -59 modifier.
Hope this helps!
Click to expand...

Yes, this IS helpful. Is what you're stating documented anywhere I can read? (The part about once per fraction, no matter how many sites?) I am so exceptionally confused by all of this and don't know where to start.
Thanks again!
 
I'm not sure where you are located but it actually states it in our LCD.

"Multiple treatment sessions on the same day are payable as long as there has been a distinct break in therapy services and the individual sessions are of the character usually furnished on different days. When billing for multiple treatments on the same day, the claim must document that there has been a distinct break between therapy. Statements such as "A.M. and P.M. treatments" suffice."

I kind of think of it as basic CPT though, if another code is a better fit, then you should use that instead. I don't know to much about Dermatology coding but I imagine it would be similar to an excision of a lesion. If you excise a 2.0 cm lesion, you wouldn't bill it as a 11400 x4 (.5cm) but would rather use 11402 x1 (for 1.1-2.0cm).

Hope this makes sense and helps you out!

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