March 31, 2010
Top Billing Errors & Denials for External Beam Radiation Oncology

The New York Times recently released a series of articles on radiation oncology and safety that has brought radiation treatment to the forefront of the arena for scrutiny. Along with all of the health-related agencies such as RAC and HEAT that have recently been created to audit and discover fraudulent or incidental errors it seems only prudent to go over some of the more basic errors for our specialty. Making sure your billing staff is trained properly can add extra measures of safety to your clinic when it comes to rules and regulations. Well-trained billers can act as a “watch dog” of sorts

Below you will find some of the most common billing errors and denials we have run across:

1. Billing for clinical treatment planning (77261 – 77263) without proper written documentation.
2. Billing a special physics procedure (77370) for IMRT QA. QA is part of the IMRT plan and is not a separate charge.
3. Billing a diagnostic CT code for the CT data acquisition portion of the initial treatment plan. The correct code is 77014. A clinic should bill this code whether they get paid or not.
4. Billing a complex simulation (77290) when a virtual simulation is completed. This can be tricky because you should always check with the carrier to see if this is approved. Some MAC carriers allow for it and some do not.
5. IMRT treatment planning (77301) and IMRT treatment delivery (77418) for prostate cancer is under scrutiny when it comes to Gy escalation. A good example of one medical policy is BCBS of Texas which states “treatment of malignant lesions of the prostate in individuals with an intact prostate when dose escalation > 72 Gy is planned …”
6. Billing the weekly management code (77427) incorrectly. Most MAC carriers have some sort of guidelines that state they want this code billed on the first or the last fraction for each series of five (5).
7. It is inappropriate to bill a weekly management code (77427) when performing brachytherapy as the sole treatment. Weekly management codes are only associated with external beam treatment.

October 20, 2009
RADMAX, LTD. Discusses New Radiation Oncology CPT Codes

Tyler, Texas. - NEW CODES FOR 2010

There are new codes effective January 1, 2010 that directly affects the specialty radiation oncology.

77338 – Multi-leaf collimator (MLC) device (s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan.

77338 is a replacement code for 77334 (Treatment devices – complex) only for the MLC used to define the fields during an IMRT plan. When you bill this code you will only bill with a quantity of one (1) no matter how many MLC’s were used during the planning process. 77338 will not replace 77334 when you report an IMRT compensator based plan.

Interstitial Placement Codes

32553 – Placement of interstitial device (s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-thoracic, singe or multiple.

49411 - Placement of interstitial device (s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple.

For more information about RADMAX, LTD call Toll Free 877.839.9517, email info@radmaxonline.com or logon to http://www.radmaxonline.com.