What CPT code to use for VisionRT?

[XRT_doc]

Hi,

What CPT code can I use for the professional component of the imaging for surface guided radiotherapy with VisionRT?

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[radiaterMike]

I’d assume IGRT but I’ll plead ignorance. Most rad onc industries provide practices with a list of codes that are billable for their product (and these would be part of the business plan in purchasing it). Vision RT is owned by Varian I believe, so I’d assume they would provide this to you.

 

[deleted1002574]

Same as for cbct

 

[seper]

I've seen 77387 being used.

 

[XRT_doc]

So CBCT has a CPT code of 77014 and has an wRVU = 0.85 while 77387 has a wRVU = 0

Which is the correct one?

 

[Neuronix]

IGRT in 2016 - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

The latest ruling and information on IGRT.

www.astro.org

However, CPT code 77387 did not receive an assigned reimbursement value in the MPFS. Providers billing under Medicare were instructed to report IGRT services using the following Healthcare Common Procedure Coding System (HCPCS) G-codes and CPT code:

• G6001: Ultrasonic guidance for placement of radiation therapy fields
• G6002: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
• G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
• 77014: Computed tomography guidance for placement of radiation therapy fields

So my best guess would be to keep using 77014. But if 77014 is really only for CT, is this really ok? Yet another gray area in rad onc billing?

 

[scarbrtj]

I’m not a biller but you def can’t use a CBCT code on something that is not CT.

 

[Neuronix]

I’m not a biller but you def can’t use a CBCT code on something that is not CT.

So just use an unpaid code? Might be the only option.

 

[scarbrtj]

So just use an unpaid code? Might be the only option.

Not an unpaid code. Somebody’ll get paid... the hospital, the freestanding owner, etc.

 

[BobbyHeenan]

I’m not a biller but you def can’t use a CBCT code on something that is not CT.

I agree with this, I wouldn't use a CBCT code. We are fighting major battles with some insurers over completely legit CBCT codes as is, so I wouldn't touch visionRT with a 10 foot pole going to a CBCT code.

Not sure if G6002 it would work?

 

[BobbyHeenan]

77387

I think this is probably most correct. Unfortunately, some insurers (?most?) list it as an "unlisted code, please call for reimbursement details" and you find out it's just not reimbursed.

One insurerer told us we should bill our CBCTs with that code. So we said, "OK, that's not correct, but if we do what does it pay?"
answer: nothing.

 

[evilbooyaa]

I'm not sure what this pays, but sounds like G6017 is your best bet? Just read the bolded.

"G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment "

 

[scarbrtj]

"A new CPT code for image guidance was created in 2015: 77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed. However, CPT code 77387 did not receive an assigned reimbursement value in the MPFS. Providers billing under Medicare were instructed to report IGRT services using the following Healthcare Common Procedure Coding System (HCPCS) G-codes and CPT code:
G6001: Ultrasonic guidance for placement of radiation therapy fields
G6002: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
77014: Computed tomography guidance for placement of radiation therapy fields
These codes can also be used to report the professional component (PC) of IGRT services for providers in a hospital setting by attaching the -26 modifier to the codes. Note: G6017 is a technical-only code, therefore the -26 modifier cannot be attached... In the hospital setting, the professional component (PC) of IGRT should still be reported with IMRT by attaching the -26 modifier to G6001, G6002, 77014 and/or 77387."

" Payers describe incorrect claims that report port films (CPT 77417), IGRT codes (CPT 77387, 77014, G6001, G6002, G6017), and/or simulation codes (CPT 77280, 77285, 77290, +77293) for each session of SRS or SBRT."

So in summary:
1) You could bill 77387. Never bill 77387-TC with IMRT or SBRT etc. You can bill 77387-26 with IMRT; it has no value. You can't bill 77387-26 with SBRT or SRS.
2. Owners of the 3D surface tracking tech can bill G6017 w/IMRT, but probably not in a hospital because tech IGRT codes are "bundled" w IMRT delivery. A physician non-owner can't bill anything for G6017; ie there is no G6017-26.
3. Never bill G6017 w/ SRS or SBRT.
4. VisionRT... why hasn't it caught on?

 

[BobbyHeenan]

I *heard* that Varian distanced themselves from visionRT recently where as before maybe they were ?partners? I don't know....like scarbrtj saying - if you can't get reimbursed for it it'll never catch on...unless it speeds up work flow (doubtful) or moves the needle on toxicity (doubtful).

 

[scarbrtj]

I *heard* that Varian distanced themselves from visionRT recently where as before maybe they were ?partners? I don't know....like scarbrtj saying - if you can't get reimbursed for it it'll never catch on...unless it speeds up work flow (doubtful) or moves the needle on toxicity (doubtful).

They're losin' their lobbying mojo. Which is bad for all of us.

 

[Neuronix]

I *heard* that Varian distanced themselves from visionRT recently where as before maybe they were ?partners? I don't know....like scarbrtj saying - if you can't get reimbursed for it it'll never catch on...unless it speeds up work flow (doubtful) or moves the needle on toxicity (doubtful).

I think it's because they're promoting their own IDENTIFY product which is similar.

IDENTIFY | Varian

Picture the future of SGRT

www.varian.com

 

[evilbooyaa]

Not to be that guy and maybe this entire thread should be moved to the business forum, but why would we expect professional reimbursement for visionRT? What is the physician doing that he/she should get paid for?

 

[XRT_doc]

Not to be that guy and maybe this entire thread should be moved to the business forum, but why would we expect professional reimbursement for visionRT? What is the physician doing that he/she should get paid for?

If nothing else, supervising the therapists.

 

[scarbrtj]

Not to be that guy and maybe this entire thread should be moved to the business forum, but why would we expect professional reimbursement for visionRT? What is the physician doing that he/she should get paid for?

Having to sign a bunch of notes.

 

[Gfunk6]

I think it's because they're promoting their own IDENTIFY product which is similar.

IDENTIFY | Varian

Picture the future of SGRT

www.varian.com

As I understand it, Varian is trying to extricate themselves from collaborations with our companies on the hardware front (e.g. BrainLAB, Vision RT). As Neuronix stated, their vision is to have comparable products and fully integrate them with their linacs. That way, when there is a problem you just call your Varian engineer - no need to call multiple companies who, at times, will simply point an accusing finger at the other.