This is the third post in our Radiation Therapy Billing FAQ Series. Billing is an essential function in radiation therapy departments but can be challenging for any clinician. Certain codes can be interpreted in various ways and insurance companies often have different acceptance criteria. To help alleviate anxiety around the topic, we’ve answered a few frequently asked questions. The information contained in these responses can be found in greater detail through a variety of billing references, such as ASTRO and Coding Strategies.
The opinions stated here reflect those of employees at Radformation based on coding experience and available resources. These opinions are based on commonly used references, and Radformation makes no formal recommendations on how departments execute their billing. Check with your local insurance payers before deciding on the appropriateness of coding for any procedure codes. Radformation (or its employees or agents) shall bear no liability for any claims made arising from the use of the following opinions.
1. What work should go into a verification simulation?
During verification simulation, the treatment target and isocenter are localized and verified through imaging. Any imaging acquired during verification simulation is included in the verification simulation code and should not be billed separately. Regardless of the complexity or type of imaging acquired, verification simulations are coded as CPT 77280. In addition to target and isocenter verification, a verification simulation is used to ensure treatment field blocking created during planning is appropriate. There must be a QA of all beam modifying devices, typically done by imaging the treatment fields with MLC or blocks on the patient at the treatment isocenter location. If some fields cannot be imaged with beam modifying devices, physician review of the blocking on the patient may be appropriate if documented appropriately. All images and verification simulation documentation should be reviewed and approved by the radiation oncologist prior to the start of the treatment.
Resource: CMS Manual System
2. Can IGRT be charged if the patient came on a day prior to the first fraction for imaging but a verification simulation wasn’t performed?
3. Are single image x-rays considered IGRT?
4. Should CPT 77014 be used for patient simulations?
Resource: ASTRO 77014 Coding Guidance
5. How should optical surface monitoring be handled when performed with IGRT?
When coding for optical surface monitoring in a hospital setting, CPT 77387 should be used to reimburse the technical component to the hospital with 3D treatments only. Physicians in the hospital settings should use HCPCS G6017 with a modifier 26 for the professional component for both 3D and IMRT treatments. In the freestanding facility, only HCPCS G6017 should be used for both professional and technical components. If multiple forms of IGRT are performed during any given fraction, each form is not separately reimbursable. IGRT codes, including optical surface monitoring, should not be billed with SRS or SBRT service as they are already bundled into the treatment delivery codes.
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