Simulation
Coding Question: How does one bill for respiratory gating during treatment?
Coding Answer: CPT® code +77293 was added to the radiation oncology code set as an add-on code. CPT code +77293 is utilized to capture the work associated with respiratory motion management and is billed once on the same date of service as treatment planning code 77295 or 77301. If the patient receives treatment utilizing respiratory gating or other respiratory motion tracking, HCPCS code G6017 or CPT code 77387 should be used. G6017 or 77387 may be used daily when respiratory motion tracking is used as part of the treatment process, depending on the requirements of the individual payer.
Coding Answer: Simulations may be reported more than once when required for separate fractions of treatment. For example, if the brachytherapy is performed twice a day (BID), each treatment may require a verification simulation be billed without a modifier, but the simulation performed for the second brachytherapy administration would have modifier 76 (repeat service) appended to the procedure code. Certain payers may prefer modifier 59 (distinct procedure) on the second simulation code, or may require that the verification simulation be charged with two units. Physicians are encouraged to contact individual payers to confirm how they want this reported. If a denial is made for -76 modifier, a modification to -59 may be advisable.
Coding Question: Can the facility charge a simple simulation 77280 the first day of treating an electron boost without an image being taken?
Coding Answer: A simple simulation (77280) on the first day can be charged for an electron boost to verify patient setup including the block location, block design, gantry clearance and isocenter. The electron cutout documentation should include a hard copy or electronically archived images, or a photograph. All documentation, including any images of treatment devices, must contain the physician signature and evidence of physician participation.
Coding Question: If one does the work of the 4-D CT evaluation and finds out that the tumor is fixed and gating is not needed, is the code to report the work still a billable charge with appropriate documentation?
Coding Answer: Yes, at times the respiratory movement of the tumor is minimal and respiratory gating may not be indicated. However, 4-D CT evaluation is indicated to confirm that the tumor is not mobile and should be reported with appropriate documentation of medical necessity. Even though respiratory movement of the tumor may be minimal, the motion of surrounding critical structures (organs at risk) relative to the target may need to be considered. For example, the margin for the lung or heart may need to be adjusted due to respiratory motion.
Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2015, American Medical Association. All Rights Reserved.
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