Billing Question: CBCT (77014) and Complex Isodose Plan (77307) on same day

[napoleondynamite]

Anyone else run into this problem? It seems as of January 1st we cannot bill a daily CBCT the same day as a boost plan. Am I missing something or has anyone found a workaround to this?

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[BobbyHeenan]

I usually don't use CBCT for image guidance for my complex isodose plans. For complex isodose plans (whole brain, simple bone mets, etc) I usually just do weekly imaging, so I haven't run into this that I can recall.

I do sometimes bill a complex isodose for a breast boost and if I have to change the iso for the boost portion of that then I will do/bill another simple simulation (which insurance may try to bundle the 77280 simple sim with the 77307 complex isodose plan if billed on the same day).

Give me an example of the case, etc and I may be able to shed some light or ask one of our billing specialists....

 

[napoleondynamite]

Thanks for the reply.

My example is prostate. I do daily CBCT and in patients who require more than one plan (e.g. high risk 45Gy to nodes, then boost) we used to be able to bill a complex isodose for that boost plan. But as of January 1, we can only bill either the daily CBCT or the complex isodose on the same day.

 

[Damn_Daniel]

Might be wrong, but I thought as of this year, for prostate (and a few other sites) the CBCT was part of the "package" for IMRT treatment delivery. Maybe that's why you can't bill for the individual CBCT - it's included in the charge.

From ASTRO:

Coding Question: How do we report image guidance with IMRT using the new CPT codes in 2015?

Coding Answer: The new IMRT treatment delivery CPT codes (77385 and 77386) include guidance and tracking, when performed. The technical component of IGRT (77387-TC) is packaged into the IMRT service with which it is performed, and is not reported separately in either the freestanding or hospital setting. However, the professional component (PC) of IGRT can still be reported.

In the freestanding setting, the physician reports the correct IMRT code and the professional component (PC) of IGRT. In the hospital setting, the hospital reports the correct IMRT code, and the physician reports the PC of IGRT. To report the PC, a physician would typically bill 77387 with the -26 modifier attached. However, CPT code 77387 did not receive a value in the MPFS in 2015. Therefore, to report the PC of IGRT services in 2015, the physician may attach the -26 modifier to one of the following codes: G6001, G6002, G6017 and/or 77014 depending on the modality used to perform the IGRT services.

 

[napoleondynamite]

yah..maybe prostate is a bad example..I think you're right. But similar problem in other disease sites where you might have a boost and you also use daily imaging the same day..

 

[BobbyHeenan]

For multiple IMRT plans (prostate plus nodes followed by boost) I generally just bill one IMRT plan for everything. I think one of my partners does bill the 77307 for the boost but I"m not sure. I know you can't bill more than one IMRT plan unless the patient needs re-simulated (significant tumor shrinkage or weight loss, etc).

I will bill the dose calcs on the IMRT boost plan, but not a new plan. As I understand it, it's likely the dose calcs are going away and getting bundled for IMRT next year (as they have been removed from complex isodose and 3-d conformal plans as of 2016).

Regarding Daniels comment - CBCT's are "bundled" on the technical side, but as of now a physican billing professional codes can still bill fo ra daily CBCT with the 77014 code with a -26 modifier.

 

[Damn_Daniel]

Thanks. That's informative.

 

[napoleondynamite]

For multiple IMRT plans (prostate plus nodes followed by boost) I generally just bill one IMRT plan for everything. I think one of my partners does bill the 77307 for the boost but I"m not sure. I know you can't bill more than one IMRT plan unless the patient needs re-simulated (significant tumor shrinkage or weight loss, etc).

I will bill the dose calcs on the IMRT boost plan, but not a new plan. As I understand it, it's likely the dose calcs are going away and getting bundled for IMRT next year (as they have been removed from complex isodose and 3-d conformal plans as of 2016).

Regarding Daniels comment - CBCT's are "bundled" on the technical side, but as of now a physican billing professional codes can still bill fo ra daily CBCT with the 77014 code with a -26 modifier.

Yes, that's the approach I had been using as well..billing for the calcs but not the plan. I think the dose calcs have gone away as of January 1.