There are scenarios that both codes could be reported the same date of service. For example, image guidance via cone beam CT (CPT 77014) is performed before treatment is delivered (to locate the planned treatment "center"), but after treatment, the weekly port film(s) (CPT 77417) are obtained as per MD order for weekly portal imaging (which demonstrates the blocking, size of treatment beam, etc. as well as treatment "center".) There are 2 different technologies used, providing 2 different "perspectives" of accuracy in treatment delivery. All Medicare LCD's are prefaced with the instruction that services must be medically necessary - so reporting 77014 and 77417 for the same clinical purpose does not meet this requirement. Documentation to clearly define purpose and analysis of imaging important. Note that Medicare LCD's tend to not follow new technology well. Hope this helps and good luck!
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