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Coding Questions

The following provides a sample of coding questions that were submitted by Clients, and subsequently published in our Newsletters. Churchill has responded to over 5,000 coding questions posted to our client's private accounts. Our Newsletter subscription provides Clients with a private account to post their coding questions.

The following link will provide you with a summary of topics that are included in our Newsletters.

  • Churchill_Newsletter_Topics.pdf
  • Please use the following order form to subscribe to the Churchill Newsletter, to renew your Newsletter, or to order question only packages.

    When looking for a topic, just use the 'control F' function, and type in the word or code that you are looking for.

    QUESTION #-109: Dose Calculations for Brachytherapy

    Are dose calcs billable with brachytherapy isodose plans?

    NEWSLETTER: October 2015, Volume #1, Issue 2

       
    QUESTION #-108: Dose Calcs

    Can the dose calcs (77300) be reported in addition to an electron (77321)?

    NEWSLETTER: October 2015, Volume #1, Issue 2

       
    QUESTION #-107: Weekly Treatment Management

    Can weekly treatment management code 77427 be billed for complex delivery brachytherapy code 77778, if the 77778 follows an EBRT course of treatment?

    NEWSLETTER: October 2015, Volume #1, Issue 2

       
    QUESTION #-106: Verification Simulation

    Can I bill a verification simulation (77280) with an IMRT plan?

    NEWSLETTER: October 2015, Volume #1, Issue 2

       
    QUESTION #-105: Course Total 32 TX in 7 Calendar Weeks

    A patient is treated for a course of IMRT treatment. The order and prescription call for 7 weeks of treatment for a total of 35 fractions. The total course ends during the 7th week at 32 treatments. How many weekly physics charges can we bill for this course?

    NEWSLETTER: September 2015, Volume #1, Issue 1

       
    QUESTION #-104: 3D Boost – IMRT Regimen

    The patient had an initial planning volume treated with IMRT. The boost volume was planned using the same dataset and resulted in a 3D plan. Can I bill 77295 when the boost starts?

    NEWSLETTER: September 2015, Volume #1, Issue 1

       
    QUESTION #-103: Dose Calculations

    Can I bill the calculations (77300) with a complex isodose plan?

    NEWSLETTER: September 2015, Volume #1, Issue 1

       
    QUESTION #-102: 2D or 3D

    We are treating a shoulder. We obtain a CT data acquisition during the simulation. As we use the CT dataset to plan, does this automatically make the plan 3D?

    NEWSLETTER: August 2015, Volume #7, Issue 147

       
    QUESTION #-101: Simulation for Clinical Electron Setup

    Do we bill a simulation if the physician designs the treatment field while the patient is lying on a stretcher and treated after the custom cutout is made, or do we only bill the treatment because all work is done on the same day? No images were taken.

    NEWSLETTER: August 2015, Volume #7, Issue 147

       
    QUESTION #-100: Breast Planning Full Course

    Our physician planned the tangent and electron boost prior to the start of treatment. What do we charge for the planning, and then how do we bill the simulation when the physician confirms the electron boost when it starts?

    NEWSLETTER: August 2015, Volume #7, Issue 147

       
    QUESTION #-99: Breast Boost Planning

    The patient was treated to tangents that were 3D planned. The physician did not do the boost plan until the time of the boost, as she was waiting to see if there was any change in the seroma. The same dataset was used to plan the electron boost portal and a custom cutout was constructed. How do we bill the planning for the boost?

    NEWSLETTER: August 2015, Volume #7, Issue 147

       
    QUESTION #-98: SRT Simulation

    We use a removable head-holder for our SRT cases. The physician likes to have the patient come in before the first treatment after planning is done to confirm everything. Can we bill a simulation?

    NEWSLETTER: May 2015, Volume #4, Issue 144

       
    QUESTION #-97: Simulation Bi-Lateral Breast

    Can we add a modifier if we do a simulation for both breasts?

    NEWSLETTER: May 2015, Volume #4, Issue 144

       
    QUESTION #-96: No MD at Simulation

    If our physician is not available for a simulation, but the images are reviewed before the treatment, can a simulation still be reported?

    NEWSLETTER: May 2015, Volume #4, Issue 144

       
    QUESTION #-95: Repeat Simulation

    There were multiple changes during the simulation before the first treatment. Can we bill another simulation before the treatment on day two?

    NEWSLETTER: May 2015, Volume #4, Issue 144

       
    QUESTION #-94: Simulation & IGRT

    Prior to the first treatment, our physician uses CBCT to confirm the isocenter and port films to confirm the shielding. Can we bill both?

    NEWSLETTER: May 2015, Volume #4, Issue 144

       
    QUESTION #-93: Multiples of 77307

    We often treat multiple metastatic areas. An isodose plan is done for each area treated. We are getting denials when we report more than one. Why?

    NEWSLETTER: April 2015, Volume #3, Issue 143

       
    QUESTION #-92: Field in Field

    Does a field-in-field breast technique automatically become IMRT?

    NEWSLETTER: April 2015, Volume #3, Issue 143

       
    QUESTION #-91: Nutritional Services during Treatment

    We have all our patients see the dietitian during treatment. Can we bill for this service?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-90: Multiple Sites Treated in one Week

    We have a patient being treated to the spine area for ten fractions. We are also treating a rib area with a single fraction. Can the physician bill 77431 for the rib on day one, and then 77427 for the five fractions if we bill them on different dates?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-89: POR Weekly Management

    We always report weekly management using the NPI number for the physician of record. We have a new physician who tells us this incorrect. Do we need to change the physician's provider number if another physician sees the patient (in same group), or can we default to the physician of record?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-88: Multiple Physicians See Patient in one Week

    When more than one physician sees the patient during the same week, how should we report it? If physician 'A' is the patient's physician and 'A' sees the patient once, and physician 'B' sees the patient twice because the patient is having problems, should we use the physician who sees the patient more times during that week?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-87: DOS Weekly Management

    Do we have to report weekly management on the date of their progress note?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-86: Follow Up During Treatment

    If a patient develops a new problem while on treatment, can the physician bill a consult?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-85: NPPN for Weekly Visits

    Our department uses the services of a nurse practitioner. Can we bill weekly management when she sees the patient in place of the physician?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-84: Port Films and Stereoscopic

    Prior to the first treatment we use kV imaging to adjust the isocenter, then we take port films to confirm the MLC. Can we bill 77387 and 77417, or should we report a simulation?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-83: Port Films Last Two Fractions

    We take port films every Monday. If there are only two fractions in the final week, can we bill 77417?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-82: Daily Port Films

    We have a patient that is difficult to setup; the physician has ordered daily port films. Can we bill 77417 daily because we have an order?

    NEWSLETTER: February 2015, Volume #2, Issue 142

       
    QUESTION #-81: 77295 for Two Lung Lesions

    We have one CT dataset but did two plans, one for a lesion in the right lung and one for a lesion in the left lung. Can we report two plans?

    NEWSLETTER: January 2015, Volume #1, Issue 141

       
    QUESTION #-80: Shoulder Block

    We are treating a shoulder met that has two corner blocks using MLC. Is this a complex device because we are using MLC?

    NEWSLETTER: January 2015, Volume #1, Issue 141

       
    QUESTION #-79: Physician at Simulation

    Who says the physician has to be present to report a simulation?

    NEWSLETTER: January 2015, Volume #1, Issue 141

       
    QUESTION #-78: Electron Boost Simulation Charge

    If the original CT is used to plan an electron boost for a breast case, should physics be the one who reports the simulation when the DRR is approved?

    NEWSLETTER: January 2015, Volume #1, Issue 141

       
    QUESTION #-77: Basic Dosimetry in 2015

    The new isodose planning codes and brachytherapy planning codes include basic dosimetry. Will there ever be a circumstance when the 77300 is reported in addition to the brachytherapy plan?

    NEWSLETTER: October-November 2014, Volume #8, Issue 139

       
    QUESTION #-76: Tandem Ovoid Plans

    We generate a new isodose plan for every T/O application. Can we report 77295 each time, or should we report 77290 and 77328 for the repeat applications?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-75: Prostate Seed Post Plan

    Is there a time limitation for reporting a post plan for a prostate implant? Can we report the post plan if it is not done for three (3) months after the implant?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-74: Cylinder Plans

    We generate a new isodose plan from the images used to confirm the placement of the cylinder for every application. Can we report 77295 each time, or should we report 77290 and 77328 for the repeat applications?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-73: What CT Level for Post Seed Imaging

    We are wondering if we should report 76873 or 77014 for the CT scan done for the post seed implant. The physicians do not think that 77014 is correct because we are not placing fields.

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-72: Brachytherapy Simulation Level

    Based on the 2014 simulation descriptions, are all brachytherapy simulations now complex?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-71: Simulation Documentation

    Do we need a simulation note when a CT data acquisition is done to confirm the placement of the brachytherapy device?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-70: Ultrasound to Confirm Device Placement

    We use ultrasound to confirm the placement of the MammoSite device before each treatment? If the MD note indicates they used ultrasound imaging to check the balloon for each treatment, would 76950 be appropriate to bill vs. 77280 since the note states U/S? Or can we report the ultrasound and also report a simple simulation?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-69: CT Data Acquisition to Confirm Device Placement

    We use the CT simulator to confirm the placement of the Savi device before each treatment? Do we report the CT data acquisition in addition to the simulation? If yes, can we report it twice, one for the morning and one for the afternoon?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-68: Weekly Physics with Seed Implant

    Can we report a weekly physics charge when the post-seed implant imaging is obtained?

    NEWSLETTER: June 2014, Volume #5, Issue 136

       
    QUESTION #-67: 77470 Whole Breast

    Would it be appropriate to bill a 77470 Special Treatment procedure for a patient who will be receiving whole breast 16 treatment Canadian regimen, as it would be considered accelerated fractionation?

    NEWSLETTER: April 2014, Volume #3, Issue 134

       
    QUESTION #-66: 77470 with EBRT and Brachytherapy

    Can we report 77470 for the external beam when the patient has chemoradiotherapy and again when they have a brachytherapy boost? If not, what date do we report?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-65: Weekly Physics with Brachytherapy

    Can we report weekly physics with brachytherapy?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-64: 77470 Brachytherapy

    Can we report special treatment procedure with all brachytherapy cases?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-63: Tandem Ring Device(s)

    Can we report two devices when we use a tandem and ring?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-62: Multiple Devices in Brachytherapy

    For our cylinder cases, we often use a sleeve. Can we report both devices?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-61: Library Plans

    For our GYN brachytherapy cylinder cases, we use a library plan. Can we report an isodose plan for each application?

    NEWSLETTER: February-March 2014, Volume #2, Issue 133

       
    QUESTION #-60: 77290 & 77295 on the Same Day

    Now that 77295 was moved to the dosimetry category, can we report a simulation if performed on the same day?

    NEWSLETTER: January 2014, Volume #1, Issue 132

       
    QUESTION #-59: Simulation with IGRT

    If cone beam or stereoscopic images are used for the block verification simulation, does that make the charge complex now?

    NEWSLETTER: January 2014, Volume #1, Issue 132

       
    QUESTION #-58: BVS or IGRT

    When IGRT images are used for a simulation, and adjustments are made, can we report a simulation and 77014 or 77421? Also, does the physician have to be there for a block verification simulation or can the physician approve the images at a workstation but not see the patient?

    NEWSLETTER: November 2013, Volume #7, Issue 130

       
    QUESTION #-57: SBRT Documentation

    We would like to know if a daily physician note is required for SBRT?

    NEWSLETTER: November 2013, Volume #7, Issue 130

       
    QUESTION #-56: Medicare Denying Professional Charges for Inpatient

    Our physicians often provide services for inpatients at an affiliated hospital. We are a freestanding center. We report the professional component of the service with modifier -26, POS 11. They are denying all charges. Please assist.

    NEWSLETTER: August-October 2013, Volume #6, Issue 129

       
    QUESTION #-55: Two Consults – Two Modalities

    Will both the radiation oncologist and medical oncologist be paid if they see the patient for consult on the same day?

    NEWSLETTER: August-October 2013, Volume #6, Issue 129

       
    QUESTION #-54: IGRT Technical Only?

    Our physicians don't always review their images prior to the next treatment. When we do the imaging we capture the charge. If the physician doesn't review the image, they don't report the professional component, but we still report the technical because we did the work. One of our physicians said this is incorrect. Is he right?

    NEWSLETTER: June-July 2013, Volume #5, Issue 128

       
    QUESTION #-53: Why is First Simulation Complex

    Why would we report a simulation when we get a CT? Our physician feels that this is a complex simulation. Is that correct, how can it be considered complex when there are no blocks yet?

    NEWSLETTER: June-July 2013, Volume #5, Issue 128

       
    QUESTION #-52: Weekly Physics with Brachytherapy

    Can we report weekly physics with brachytherapy? We see that it is listed in the HDR TREES but not in the prostate seed implant.

    NEWSLETTER: June-July 2013, Volume #5, Issue 128

       
    QUESTION #-51: Weekly Physics Denial

    We were denied a weekly physics charge recently. There was a documented check performed the day after the patient completed treatment. We submitted the documentation but we were still denied. Any assistance would be appreciated.

    NEWSLETTER: June-July 2013, Volume #5, Issue 128

       
    QUESTION #-50: Immobilization and Simulation

    Does custom immobilization automatically result in a complex simulation 77290?

    NEWSLETTER: May 2013, Volume #4, Issue 127

       
    QUESTION #-49: Simple Simulation with SBRT

    Can we report a simple simulation on the first SBRT day?

    NEWSLETTER: May 2013, Volume #4, Issue 127

       
    QUESTION #-48: New CT for Boost

    The physician ordered a new CT for the boost. What do we charge?

    NEWSLETTER: May 2013, Volume #4, Issue 127

       
    QUESTION #-47: Simulation Multiple Areas

    We are simulating two areas and need to get a CT for each area. Can we bill 2 x 77014 and 2 x 77290?

    NEWSLETTER: May 2013, Volume #4, Issue 127

       
    QUESTION #-46: Emergency Start

    We had an emergency situation that we had to simulate and treat the patient on the same day. The patient was seen in consult. Then the patient was simulated, planned, and simulated again on the machine before the treatment. Our medical record supports all services. Can we bill for a consult, complex simulation (77290), CT Data set (77014), and then simulation verification (77280) and treatment?

    NEWSLETTER: May 2013, Volume #4, Issue 127

       
    QUESTION #-45: Rural Sites

    Are there any exceptions to the physician supervision rule for rural sites?

    NEWSLETTER: March-April 2013, Volume #3, Issue 126

       
    QUESTION #-44: Supervision

    Does a physician really have to be in the center when a patient is being treated? I thought that the guidelines have been relaxed.

    NEWSLETTER: March-April 2013, Volume #3, Issue 126

       
    QUESTION #-43: SRS and Simulation

    We are treating a brain with SRS, planning and treating on the same day. If we add a modifier can we report 77290 for the simulation and 77295 for the planning?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-42: SRS and 3D Planning

    We are treating a brain with three lesions with SRS. The physician must contour and plan each lesion. Can we report 77295 for each lesion if we add a modifier?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-41: SBRT and IMRT Planning

    We do inverse planning for some of our SBRT cases. Do we have to report 77418 for treatment?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-40: SBRT and IGRT

    We do CBCT for our SBRT cases. Can we report 77014?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-39: SBRT – 2 Areas

    We are treating two lesions for a lung. As the treatment time is ninety minutes, the physician wants to treat each lesion for five days. Can we still report SBRT?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-38: SRT Boost

    We have a patient who was treated with 20 fractions to the whole brain. Can we do a 5 fraction SRT boost?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-37: SRS on Tomo - Calculations

    We are treating SRS on our Tomotherapy unit. How many basic dosimetry calculations should we report? I read that we can report up to 10. Is that correct?

    NEWSLETTER: February 2013, Volume #2, Issue 125

       
    QUESTION #-36: Topic: Multiple Simulations

    We are treating an electron field and multiple photon fields. Can we charge more than 1 verification simulation?

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-35: Topic: IMRT Boost

    We are treating a prostate with IMRT for 25 fractions, with a reduction to the prostate bed. Can we report 77295 for the IMRT boost plan? We print the plans on different days.

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-34: Topic: Two Simulations in One Day

    There are times that we simulate a patient, plan and treat on the same day. Can we report the pre-planning simulation, 3D isodose plan, and then the block verification simulation (BVS) in addition to the initial simulation by appending the -59 modifier?

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-33: Topic: Virtual Simulation

    Can we bill the technical component for the virtual simulation process if no doctor is on site when the plan is completed and DRRs generated?

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-32: Topic: 3D Plan for APBI

    When we do accelerated partial breasts with brachytherapy, we usually simulate the patient on the dedicated CT simulator on a Thursday, reporting 77290. We do the 3D plan on Friday, but the attending who does these cases has off Friday. The plans are always approved Monday before treatment, which is when we bill them. We are getting denied the two simulation charges, even when we add a modifier. Do you have any recommendation?

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-31: Topic: Simulation Level with Custom Immobilization

    What level simulation should we report when we have a simple open spine field, but the physician requires custom immobilization because the patient was treated before?

    NEWSLETTER: October 2012, Volume #8, Issue 122

       
    QUESTION #-30: Topic: Bolus

    Can we charge an intermediate device charge for bolus on the first day of treatment for a chestwall? Should we add the -59 modifier? We charge the wedge with the isodose plan on a different day.

    NEWSLETTER: August-September 2012, Volume #7, Issue 121

       
    QUESTION #-29: Topic: DOS Clinical Treatment Planning

    When our physician receives a consult, they prepare a clinical treatment planning note ahead of time after discussing the case with the referring physician, billing for it before they see the patient. Is this appropriate?

    NEWSLETTER: August-September 2012, Volume #7, Issue 121

       
    QUESTION #-28: Topic: Gating & SBRT

    We are doing a lung SBRT using our CyberKnife. What is the charge for the initial 4D simulation? Also, is the gating device reported as a complex device with 77334?

    NEWSLETTER: August-September 2012, Volume #7, Issue 121

       
    QUESTION #-27: Topic: 77470

    When is it appropriate to report 77470 and who is responsible for the documentation? If the physician checks this code on an order form, is that enough?

    NEWSLETTER: August-September 2012, Volume #7, Issue 121

       
    QUESTION #-26: Topic: Electron Isodose Plans

    When we generate an electron plan with beams for a breast boost, do we report 77315, 77321, or both?

    NEWSLETTER: August-September 2012, Volume #7, Issue 121

       
    QUESTION #-25: Topic: Supervision Level for Zevalin

    What are the physician supervision requirements for Zevalin infusions?

    NEWSLETTER: June 2012, Volume #5, Issue 119

       
    QUESTION #-24: Topic: Tomotherapy Basic Dosimetry

    We report 1 x 77300 for all Tomotherapy cases. Is that correct?

    NEWSLETTER: June 2012, Volume #5, Issue 119

       
    QUESTION #-23: Topic: Simulation

    Our physician writes an order for the simulation and immobilization, but we do all of the work. Our patients are setup via protocol. We simply do not need to bother the physicians. They are in the department but we don't call them unless we need them. Is there a problem reporting simulation?

    NEWSLETTER: April-May 2012, Volume #4, Issue 118

       
    QUESTION #-22: Topic: Physician Management

    Our physician saw a patient before their first treatment. She did not see the patient again until fraction 9. Can the note from before the treatment began be counted as an OTV note for week 1?

    NEWSLETTER: April-May 2012, Volume #4, Issue 118

       
    QUESTION #-21: Topic: Image Review: Supervising Physician or Reviewing Physician

    When we do IGRT, we have a physician in the department, but that physician does not always review the images. If a different physician reviews the images at the end of the day, which doctor's name do we report?

    NEWSLETTER: April-May 2012, Volume #4, Issue 118

       
    QUESTION #-20: Topic: Bite Blocks

    Can a bite block be reported in addition to the custom mask? If yes, what level?

    NEWSLETTER: April-May 2012, Volume #4, Issue 118

       
    QUESTION #-19: Topic: Machine Down

    One of our machines was down and we treated patients on a different accelerator. We had to do new isodose plans and MU calculations for every patient. Can we report a new plan and basic dosimetry?

    NEWSLETTER: April-May 2012, Volume #4, Issue 118

       
    QUESTION #-18: Topic: Prostate Monotherapy

    We are doing prostate HDR. The needles and catheters are placed interstitially in the OR, and then the patient is brought to the department for the HDR treatment. We are reporting 77778 for the operating room and 77787 for the HDR. We append the -59 modifier. Is that correct?

    NEWSLETTER: March 2012, Volume #3, Issue 117

       
    QUESTION #-17: Topic: Cylinder HDR Plans

    We obtain a CT for each cylinder application and do a new plan. Can we report 77295 every application?

    NEWSLETTER: March 2012, Volume #3, Issue 117

       
    QUESTION #-16: Topic: Cylinder HDR Device

    Can we report a device for the cylinder used in GYN HDR? If yes, what level and how often?

    NEWSLETTER: March 2012, Volume #3, Issue 117

       
    QUESTION #-15: Topic: Special Physics Consult for Fusion

    Our physicians are ordering PET fusion with the treatment planning CT if they are available. The fusion is done by the dosimetrist, not the physicist. Should 77370 be charged for this work?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-14: Topic: Simulation with SBRT

    Can a simulation or imaging be reported daily with SBRT?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-13: Topic: Electron Boost Plan with IMRT

    We have a left breast case that was planned with IMRT, but the physician prescribed an electron boost. Can the electron plan be reported?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-12: Topic: Boost Plan IMRT

    Our physicians don’t order the IMRT boost plan until mid-course. Because we are not doing the plan initially, can we report 77315 for the second plan?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-11: Topic: Verification Simulation with IMRT

    Is it appropriate to report a verification simulation on the first day of IMRT treatment?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-10: Topic: Imaging with Electron Treatment

    If the physician orders IGRT for confirming the accuracy of the electron portal, can we bill daily imaging?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-9: Topic: Gating and Port Films

    Can gating and port films be reported on the same day?

    NEWSLETTER: February 2012, Volume #2, Issue 116

       
    QUESTION #-8: Topic: Rectal Balloons

    Can you charge a device for the placement of the rectal balloon with the initial simulation?

    Can you charge a simple device charge daily when a rectal balloon is used?

    NEWSLETTER: September-October 2011, Volume #6, Issue 113

       
    QUESTION #-7: Topic: Daily Imaging

    This is a two part question. First, can we report imaging daily if it is ordered and done?

    Second, if gating and kV imaging are both ordered, can we bill both the 77421 and 0197T code? We feel that they are different procedures and both should be able to be reported.

    NEWSLETTER: September-October 2011, Volume #6, Issue 113

       
    QUESTION #-6: Topic: Special Physics Consultation for TLDs or Diodes

    1. Where does it say that a special physics consult MUST be performed by a QMP, rather than work being reviewed or overseen by the QMP?

    2. Does this include in vivo diode or TLD measurements? In this case, the actual measurement is necessarily performed by the therapists treating the patient, while the analysis is performed by the QMP. Can a SMPC be charged for the diode or TLD measurements?

    3. Also, when an electron insert measurement is performed by a Therapist, but the analysis and report is completed by the QMP, can a SMPC be charged?

    NEWSLETTER: September-October 2011, Volume #6, Issue 113

       
    QUESTION #-5: Topic: Special Physics Consultation for Rapid Arc?

    Our physicists feel that a special physics consult would be in order for all RapidArc cases as there is a lot of time associated with the physician discussions regarding planning recommendations, assisting with the simulation and the first day of treatment, imaging, QA, etc. Would it be appropriate to report 77370 if work is documented for all RapidArc cases?

    NEWSLETTER: September-October 2011, Volume #6, Issue 113

       
    QUESTION #-4: Topic: Reporting Imaging in Hospitals

    Should we be submitting the 77014 & 77421 & 77417 imaging codes to CMS Medicare since they do not receive reimbursement for imaging in Radiation Therapy?

    NEWSLETTER: July-August 2011, Volume #5, Issue 112

       
    QUESTION #-3: Topic: Reporting multiple simulations in one day

    Where does it say that multiple simulation procedures are limited to brachytherapy? Why can't we report two simulations if the patient is simulated, planned and has a block verification simulation (BVS) on the same day?

    NEWSLETTER: July-August 2011, Volume #5, Issue 112

       
    QUESTION #-2: Topic: Two Simulations on the Same Day

    A patient is scheduled for a simulation and treatment on the same day. We make a customized immobilization device and simulate the patient on the dedicated CT simulator. The physician designs custom blocks. We are charging a complex simulation (77290), custom immobilization (77334) and CT data acquisition (77014-tc). When we get to the machine, the physician wants to verify the blocks before treatment. Can another simple simulation be charged or should just a port film be reported?

    NEWSLETTER: May-June 2011, Volume #4, Issue 111

       
    QUESTION #-1: Topic: Markers and Simulation Levels

    We often use markers for the pre-planning simulation procedure, such as a vaginal marker or rectal marker. Can we report a complex device for the markers? What level is the simulation reported as?

    NEWSLETTER: May-June 2011, Volume #4, Issue 111

       
    QUESTION #1: Topic: 4D Simulation Level

    We perform 4D simulation on all lung and most abdominal patients, with custom immobilization. All patients do not require gating, but the work must be done to determine if it is required. What level is the simulation be reported as? What do we report for the extra work for the 4D simulation process?

    NEWSLETTER: May-June 2011, Volume #4, Issue 111

       
    QUESTION #2: Topic: HDR Sedation

    We are performing HDR procedures in the department with moderate sedation. Can we bill for the sedation?

    NEWSLETTER: May-June 2011, Volume #4, Issue 111

       
    QUESTION #3: Topic: Brachytherapy Isodose Planning

    We do a pre-plan, a plan in the OR and a post plan. How should we bill our planning?

    NEWSLETTER: March-April 2011, Volume #3, Issue 110

       
    QUESTION #4: Topic: VMAT IMRT

    With VMAT IMRT, if there are multiple arcs, is there a specific code to report for the daily treatments other than 77418?

    NEWSLETTER: March-April 2011, Volume #3, Issue 110

       
    QUESTION #5: Topic: Laryngoscopy Fiberoptic

    Is there a technical component for code 31575?

    NEWSLETTER: March-April 2011, Volume #3, Issue 110

       
    QUESTION #6: Topic: Electron Coding

    When an isodose plan is done for an electron boost, do we report 77315 and 77321?

    NEWSLETTER: March-April 2011, Volume #3, Issue 110

       
    QUESTION #7: Topic: Treatment (No MD in Department)

    Can you bill a treatment if the physician is not in the office/department?

    NEWSLETTER: December 2010, Volume #9, Issue 107

       
    QUESTION #8: Topic: IGRT Image Review

    Can you bill the technical component if the physician doesn't review the images prior to the next fraction?

    NEWSLETTER: December 2010, Volume #9, Issue 107

       
    QUESTION #9: Topic: IMRT Boost

    Can you bill a complex isodose plan via 77315 for the IMRT boost?

    NEWSLETTER: December 2010, Volume #9, Issue 107

       
    QUESTION #10: Topic: Simulation (No MD)

    Can you bill a simulation if the physician reviews the images prior to the next fraction?

    NEWSLETTER: December 2010, Volume #9, Issue 107

       
    QUESTION #11: Topic: IGRT & Simulation

    Can you bill a simulation and IGRT on the first day if the images are CBCT images?

    NEWSLETTER: December 2010, Volume #9, Issue 107

       
    QUESTION #12: Topic: Does Breast Qualify for 3D

    What is the major distinction between a 3D isodose plan and a standard isodose plan reported via 77315? Is it the complexity of the plan or the fact that all structures have been volumized that determine whether or not a 3D plan can be charged? We are treating a left breast tangent arrangement with MLC and wedges. The breast tissue, GTV, heart and lung are volumized with DVH's. The boost will be via electrons. Please advise what level of isodose planning should be reported.

    NEWSLETTER: November 2010, Volume #8, Issue 106

       
    QUESTION #13: Topic: Physician Image Review IGRT

    When stereoscopic imaging is done, the images include an orthogonal pair of images, which are reviewed by the physician side by side. It would make sense that only one approval note is needed, even though the films pop up as separate images. Please confirm what documentation is required.

    NEWSLETTER: November 2010, Volume #8, Issue 106

       
    QUESTION #14: Topic: Electron Plan

    Can a 77321 (Special Teletherapy Port Plan) and a 77315 (Isodose Complex Plan) be charged together on the same day for the same treatment area? Can they be charged together but on separate days for the same treatment area?

    NEWSLETTER: November 2010, Volume #8, Issue 106

       
    QUESTION #15: Topic: 77011 with SRS

    Should code 77011 be reported with SRS?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #16: Topic: RapidArc®

    When RapidArc® is used, and the plan has two arcs, is it appropriate to bill 2 x 77334 and 2 x 77300? Would you bill 1 x 77301?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #17: Topic: Images Required for BVS

    Can we report a block verification simulation (BVS) if we only confirm the isocenter on a 3D plan?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #18: Topic: Standing Order for BVS

    Can there be a standing order for block verification simulation (BVS) procedures?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #19: Topic: Pre-Ports on Treatment Day

    If we take port films (pre-ports) prior to treatment and get them approved by a physician before giving treatment (on the same day), can we bill for pre-ports via 77280?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #20: Topic: Simulation for IMRT Cone Down

    Can we charge a simple simulation when verifying a "Cone Down" with orthogonal paired port films for the same isocenter regarding an IMRT photon boost on a radiation therapy treatment unit?

    NEWSLETTER: September-October 2010, Volume #7, Issue 105

       
    QUESTION #21: Topic: Cylinder Insertion

    We have a private insurer who won't pay the 58999 for the cylinder insertions. They suggested we use S2270. I am not clear if this would be for all insurances. Have you seen this done?

    NEWSLETTER: August 2010, Volume #6, Issue 104

       
    QUESTION #22: Topic: Compensator Based IMRT

    What machines or equipment use the 0073T for IMRT compensator based? Must this be a physical compensator in the machine?

    NEWSLETTER: August 2010, Volume #6, Issue 104

       
    QUESTION #23: Topic: IMRT Boost Plan

    We received an Update from another consultant stating that it is now OK to bill a 77315 when a new IMRT plan is generated based on the original CT data set. A copy of a coding response from ASTRO was included. We wanted to get your feedback on this and can we start applying this charge to our boost IMRT plans?

    NEWSLETTER: August 2010, Volume #6, Issue 104

       
    QUESTION #24: Topic: Two Treatment Sites/How Many Daily Treatments are Reported?

    We are treating a patient in 2 entirely different locations and each location has a different DX code. We are treating each location, one after the other, and are not fractionating the treatments. Because each of the sites that we are treating has a totally different DX code, can we charge for 2 daily treatments - one for each site-DX code?

    NEWSLETTER: August 2010, Volume #6, Issue 104

       
    QUESTION #25: Topic: SRS: 2 Lesions 2 Days

    In the case of a patient who is treated for one or more cranial lesions in two treatment sessions, do you charge one unit of 77372 for the entire course or two treatment sessions, one for each fraction delivered?

    NEWSLETTER: August 2010, Volume #6, Issue 104

       
    QUESTION #26: Topic: Electron Boost Planning

    A breast patient is treated via tangent portals, which are planned with 3D planning. Can the electron boost be reported with 77321?

    NEWSLETTER: May 2010, Volume #4, Issue 102

       
    QUESTION #27: Topic: Nurse Charges

    We are a hospital based facility that employs a private physician group. We currently charge a facility room charge to correspond with the physician consults and follow ups. Can we also charge a facility bill when our nurses assist the physicians during their weekly on treatment evaluation and management of their patients?

    NEWSLETTER: May 2010, Volume #4, Issue 102

       
    QUESTION #28: Topic: Two Types of IGRT, One Course

    Our physician orders alternating types of IGRT. Cone beam CT is ordered for Monday, Wednesday, and Friday, and stereoscopic is ordered for Tuesday and Thursday. Is there a problem reporting two types of IGRT in the same course?

    NEWSLETTER: May 2010, Volume #4, Issue 102

       
    QUESTION #29: Topic: Boost Plan (77315) with IMRT

    Can a boost plan be reported with IMRT via code 77315?

    NEWSLETTER: April 2010, Volume #3, Issue 101

       
    QUESTION #30: Topic: Electron Boost with IMRT

    Can an electron boost be reported with IMRT?

    NEWSLETTER: April 2010, Volume #3, Issue 101

       
    QUESTION #31: Topic: Daily IGRT

    We alternate the type of imaging performed, using cone beam CT some days and stereoscopic on others. Is there any problem in reporting both types?

    NEWSLETTER: March 2010, Volume #2, Issue 100

       
    QUESTION #32: Topic: Second IMRT Plan

    Can we bill a second 77301 during the same course if there is significant change to the patient's anatomy and a second CT is acquired? We often see this in our head and neck cases.

    NEWSLETTER: March 2010, Volume #2, Issue 100

       
    QUESTION #33: Topic: IGRT

    Can 2 IGRT's be billed on the same DOS for 2 different volumes of interest? For example: CBCT on a spine and IGRT on shoulder fields?

    NEWSLETTER: January 2010, Volume #1, Issue 99

       
    QUESTION #34: Topic: 77338 and/or 77334?

    With respect to IMRT device charges; does 77338 replace the 77334 charges for a 6 field MLC IMRT or is it in addition to the 6 device charges?

    NEWSLETTER: December 2009, Volume #10, Issue 96

       
    QUESTION #35: Topic: 77338 and 77334?

    I have read the November Newsletter several times as have the therapists and the physics staff regarding the IMRT Device Code 77338. We are of the opinion that it can be used in conjunction with the number of IMRT Complex Devices Code 77334 created for the number of IMRT TX fields treated. Please confirm what we should be billing for our IMRT Devices. We have Linear Accelerators using MLC. We frequently treat 6 to as many as 14 IMRT fields.

    NEWSLETTER: December 2009, Volume #10, Issue 96

       
    QUESTION #36: Topic: 77338 Medicare Only?

    Does this code only apply to Medicare patients? Can we code 77334 devices for other insurances in the IMRT case?

    NEWSLETTER: December 2009, Volume #10, Issue 96

       
    QUESTION #37: Topic: Can Daily Orthogonal Films be a Simulation?

    We are currently treating a patient who cannot lie on the treatment table so we are using an unordinary set up position. In order to ensure accurate treatment, we are taking pre-treatment port films that the physician is reviewing. The physician is dictating a daily simulation note. Is it appropriate to bill for a simple simulation everyday that the patient is treated?

    NEWSLETTER: November 2009, Volume #9, Issue 92

       
    QUESTION #38: Topic: Can Weekly Orthogonal Films be a Simulation?

    Can weekly simulation be reported for orthogonal port films to check the isocenter?

    NEWSLETTER: November 2009, Volume #9, Issue 92

       
    QUESTION #39: Topic: 2D or 3D for 4-field Pelvis

    Our physician draws the shielding for a 4-field pelvis and we are reporting a complex isodose plan, code 77315. However, the physician feels that the blocks he is drawing are conformal and 3D planning should be reported. What criteria do we need to report 3D?

    NEWSLETTER: October 2009, Volume #8, Issue 91

       
    QUESTION #40: Topic: Chart Summary

    Can a therapist do the final summary chart check including the part asking if the completed chart was reviewed by physics? The dosimetrist and physicist do the weekly chart check.

    NEWSLETTER: October 2009, Volume #8, Issue 91

       
    QUESTION #41: Topic: 77321

    What is the latest regarding 77321? Our doctors' dictation includes information about their thought process for the determining of an energy at the time of the electron simulation. The electron simulation dictation includes details about the procedure via ultrasound, establishing gantry and collimator angles, skin marks and cone size. The physician also documents the estimated depth of the cavity and chest wall, which determines the electron energy prescribed. Do you think that the above documentation would cover the use of the code 77321, or would you recommend a separate note?

    NEWSLETTER: October 2009, Volume #8, Issue 91

       
    QUESTION #42: Topic: 77418 & 77413 – Can We Charge Both

    We have a patient who is being treated to two different sites on two different machines. One sight is treated on the Linac and the other sight is being treated on our Tomotherapy machine. How should we proceed with the billing for this individual?

    NEWSLETTER: October 2009, Volume #8, Issue 91

       
    QUESTION #43: Topic: Nurse in Freestanding

    We are freestanding cancer center and we split bill. The technical component is billed by the center and the physician bills the professional component separately. The nurse is the employee of the center and handles the intake of the follow up and the consults. Can we charge a nurse visit on the technical component side?

    NEWSLETTER: October 2009, Volume #8, Issue 91

       
    QUESTION #44: Topic: Confirmation Simulation Level

    After reading your August 2009 Newsletter, I want to make sure we are billing correctly. When confirming a 3D plan for the first time are you now saying bill that as 77280 instead of 77290?

    NEWSLETTER: September 2009, Volume #7, Issue 90

       
    QUESTION #45: Topic: Special Physics Consult with IMRT

    Please discuss special physics consult in regards to IMRT. Currently, out physicists do a QA check and add data from the phantom work on a worksheet titled 'special physics consult'. Is this work appropriate for a special consult, as the work is for the individual patient?

    NEWSLETTER: September 2009, Volume #7, Issue 90

       
    QUESTION #46: Topic: Immobilization with IMRT?

    Please comment on reporting immobilization for IMRT

    NEWSLETTER: September 2009, Volume #7, Issue 90

       
    QUESTION #47: Topic: Are Composite Plans Billable?

    Are we allowed to charge for a cGy composite plan in addition to a 3D plan or any boost plan where a composite plan is performed?

    NEWSLETTER: September 2009, Volume #7, Issue 90

       
    QUESTION #48: Topic: Two Confirmation Simulations

    Our physicians want to schedule two confirmation simulation procedures. They want to confirm the isocenter in one session, and then have the patient return the following day to have the blocks confirmed. What is your opinion of this?

    NEWSLETTER: September 2009, Volume #7, Issue 90

       
    QUESTION #49: Topic: 77421 Physician

    Is it necessary for the radiation oncologist to review and sign the documentation for stereoscopic 77418-TC? If so, must this be done prior to the patient's next treatment?

    NEWSLETTER: August 2009, Volume #6, Issue 89

       
    QUESTION #50: Topic: 77373 Documentation

    When performing SBRT, do we treat this like other treatment codes as far as documentation, or do the physicians need to do a daily procedure note for each treatment?

    NEWSLETTER: August 2009, Volume #6, Issue 89

       
    QUESTION #51: Topic: Prostate Volume Study

    We are a freestanding center and will now be doing prostate volume studies here at our center instead of in the hospital. If we charge for the ultrasound, can we still charge for the complex simulation (77290) that day also? There is only one study that results (the ultrasound).

    NEWSLETTER: July 2009, Volume #5, Issue 88

       
    QUESTION #52: Topic: Fusion

    We do fusion frequently, and it is a nearly automated process in our department and normally performed by the dosimetrist. I have been asked about billing for this now that the CPT Assistant (May 2009 Issue) indicates that a special physics consult can be reported for this service.

    NEWSLETTER: July 2009, Volume #5, Issue 88

       
    QUESTION #53: Topic: Bilateral Breast

    We have a patient with right and left breast cancer. We are treating both breasts on the same visit one right after the other. Can we charge for two treatments/same day?

    NEWSLETTER: July 2009, Volume #5, Issue 88

       
    QUESTION #54: Topic: Non Physician Practitioner

    What professional and technical services can be billed by the APRN?

    NEWSLETTER: May-June 2009, Volume #4, Issue 87

       
    QUESTION #55: Topic: 3D for Spine Fields

    We acquire CT data on our dedicated CT simulator to establish the ports for an open spine field. The field arrangement may be PA only, or opposed. Can we report 77295?

    NEWSLETTER: May-June 2009, Volume #4, Issue 87

       
    QUESTION #56: Topic: PET-CT

    We have a PET/CT. Some patients may already have a PET scan, which we are fusing with the CT. What would we report if another PET scan were acquired for planning purposes?

    NEWSLETTER: May-June 2009, Volume #4, Issue 87

       
    QUESTION #57: Topic: HDR Two Sites Concurrently

    A Pt had HDR to each foot with same applicator (and same treatment plan). How should this be reported?

    NEWSLETTER: May-June 2009, Volume #4, Issue 87

       
    QUESTION #58: Topic: Tandem and Ovoids Placement for HDR

    When performing a tandem/ovoid insertion in preparation for an HDR application, the GYN is not always present. Is it appropriate for the radiation oncologist to charge code 57155 for the insertion of the applicator, or is this service bundled with the HDR application codes?

    NEWSLETTER: May-June 2009, Volume #4, Issue 87

       
    QUESTION #59: Topic: Tomo Devices Based on Sinogram

    Is it appropriate to bill for multiple treatment devices for Tomo? I have been informed by the department manager that multiple units can now be billed since Version 3.0 has the ability to print out the sinogram images. Just because the image can now be produced & printed, should it be billed? The planning has not changed. Or, is the sinogram just like a fluence diagram?

    NEWSLETTER: March-April 2009, Volume #3, Issue 86

       
    QUESTION #60: Topic: Devices with Forward Planning

    At a recent billing seminar, our physicians were informed that it was appropriate to bill a treatment device charge for every segment within each beam when doing forward planning, e.g., breast. Is that true?

    NEWSLETTER: March-April 2009, Volume #3, Issue 86

       
    QUESTION #61: Topic: Rapid Arc – MU & Devices

    There seems to be some controversy on what can be billed for an IMRT plan treated with Rapid Arc. If the planning system can extract control points for the arc, can each of these control points be billed for an MU Calc and MLC or is the plan only billed for one MU and one MLC?

    NEWSLETTER: March-April 2009, Volume #3, Issue 86

       
    QUESTION #62: Topic: Follow-Up & Simulation – Same Day

    In the past, we have had patients come back for a scheduled visit at which time the MD sees the patient, obtains the informed consent, and then sends the patient for a simulation. We charge a follow-up charge and simulation charge on the same day. We have not being paid for the follow-up on the same day as the simulation. If we were to use a modifier 25 would this make a difference or is this just a CCI EDIT?

    NEWSLETTER: March-April 2009, Volume #3, Issue 86

       
    QUESTION #63: Topic: AccuForm Cushion

    We sometimes use a product called 'AccuForm cushion', which conforms to the back of a patient's head and is not reusable for other patients. Most often, we use this device with a custom mask. Can this device be reported in addition to the mask? If this were the only device, what level would we report?

    NEWSLETTER: March-April 2009, Volume #3, Issue 86

       
    QUESTION #64: Topic: Physician Management 77427

    We bill 77427 every fifth fraction, as long as the physician has documented their on treatment visit at some point during the five fractions reported. Our physicians typically see the patient on a set day during the week (ex. every Monday). If the patient starts treatment on Monday, and is seen on Monday, can we bill the weekly management on Friday (this is the fifth treatment)?

    NEWSLETTER: February 2009, Volume #2, Issue 85

       
    QUESTION #65: Topic: Weekly Physics 77336 after PT Finishes TX

    Are we able to bill this physics charge after the last treatment is given?

    NEWSLETTER: February 2009, Volume #2, Issue 85

       
    QUESTION #66: Topic: Packet Signature

    Our isodose plans and MU calculations via a second algorithmic calculation are combined into a single electronic document. Can our physicians sign a cover page for all of the work?

    NEWSLETTER: February 2009, Volume #2, Issue 85

       
    QUESTION #67: Topic: 77011

    Can we report code 77011 for our SRS cases?

    NEWSLETTER: February 2009, Volume #2, Issue 85

       
    QUESTION #68: Topic: 77014 with 77301

    We heard that the CT data acquisition code 77014 could no longer be charged at the initial simulation if it is used for IMRT treatment planning. Is that correct, can we no longer charge it for IMRT patients?

    NEWSLETTER: February 2009, Volume #2, Issue 85

       
    QUESTION #69: Topic: IGRT 77421

    Our LCD does not mention 77421 for IGRT. Should I be reporting it?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #70: Topic: DOS for Orders general

    Is it appropriate to combine the Simulation request, treatment planning and the field verification all on one sheet with one date? Which function should the date on the sheet reflect?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #71: Topic: Brachytherapy Isodose Planning for HDR

    January 1, we implemented the NEW HDR treatment codes, based on the number of channels that are used for the treatment. For the planning codes, are they remaining the same? If so, that would mean that for the plan we base it on the number of source positions and not the number of channels. It seems inconsistent to bill treatments based on the channels and the plan based on the number of source positions. Are there other new codes that would affect us?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #72: Topic: Physics Consult (77370) for IMRT QA (77370)

    Can you advise if a special medical physics consult (77370) may be reported if we are validating the control points for IMRT?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #73: Topic: Professional Component for CBCT 77014

    Is there a professional charge for Cone-beam? If so, which is the right CPT code?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #74: Topic: 3D for Breast Regimens 77295

    We wanted to confirm current billing guidelines regarding the use of 77295. Our physicians want to bill this for our tangent breast cases. Do critical structures have to be outlined by the physician in the treatment planning system in order to bill this? Would the outlining of the liver and lung on a right breast case qualify for 77295 if all the DVH's and 3D renderings were done according to guidelines?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #75: Topic: PA Reviewing Images for 77421

    We understand the MD must be present in real-time for review of images to bill the global code, as this code requires personal supervision (level 3). Can you comment on the appropriateness of a PA providing this real-time supervision and then billing the global charge?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #76: Topic: Physician Required in Department 77427

    In your last newsletter, you spoke about physician requirements in the department. We have Medical Oncologists and Radiation Oncologists on site but there are times where they cover for each other, i.e., symptom management. We don't ever do this coverage for anything else i.e. simulations or new starts on the units, but if a patient is having problems we will have them see their medical oncologist if the radiation oncologist is not available. From the newsletter it seems like to be able to treat patients at a site, we will need to ensure that a radiation oncologist is in the suite to treat any patients at all times. Is this correct?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #77: Topic: PA for Weekly Management 77427

    We have a Physician Assistant. Can he see the patients for the OTV visits each week, or must the actual physician see them in order to charge the weekly management code at the end of their treatments?

    NEWSLETTER: December 2008/January 2009, Volume #1, Issue 84

       
    QUESTION #78: Topic: Multiple Physicians Approving CBCT Images 77014

    Guidelines for supervision of cone beam CT treatments indicate that a physician needs to be "on site" but not personally present in the room for charging for this procedure. However, if the physician that "ordered/planned" the cone beam CT is not on site, and the "treatment" is charged to a different physician on site, but the "images" are reviewed and approved by the physician that ordered/planned the treatment (who is not on site at the time of the treatment) under which physician should the 77014 be charged? The actual treatment charge would go to the physician on site, and logically I would think that the 77014 should be charged to this same physician. However, if the physician that ordered/planned the course (who is not on site) approves the images, then the documentation would show a different physician than the one that was actually on site.

    NEWSLETTER: October-November 2008, Volume #6, Issue 83

       
    QUESTION #79: Topic: ICD-9 for Prophylactic Brain

    When a pt is treated prophylactically to their whole brain after being treated for lung cancer, what is the appropriate ICD-9 code to bill? We had been billing V07.8.

    NEWSLETTER: October-November 2008, Volume #6, Issue 83

       
    QUESTION #80: Topic: Isodose Plan Level for Open Met Field

    In treating palliative cases of bony mets, the physicians order treatment plans. Most, often, there are no MLCs or hand blocks. Dosimetry prints a plan with multiple images. The 1ST page is axial, coronnal and saggital views with isodose lines. Other pages that are printed are; additional page of one other important CT slice, (different than the 1ST page) then smaller images of many other slices. DDR is demonstrated also. There usually is one posterior beam. When I read 77305 Criteria, it only talks about points that would be used in an irreg plan. 77310 says multiple beams. Since we review the dose along so many images, I think that we should be billing 77310. What is your recommendation?

    NEWSLETTER: October-November 2008, Volume #6, Issue 83

       
    QUESTION #81: Topic: RapidArc 77418

    Can you tell me how we will bill for rapid arc treatments, say for a prostate patient? Now, we bill an IMRT plan, and calcs/devices for every gantry angle. How will Rapid Arc be different?

    NEWSLETTER: October-November 2008, Volume #6, Issue 83

       
    QUESTION #82: Topic: RVU for 77014

    Looking at your comparison of 2009-2008 RVUs from the July-August newsletter, the code 77014 was missing. Can you give me the proposed RVUs for the CPT code 77014, both professional and technical?

    NEWSLETTER: October-November 2008, Volume #6, Issue 83

       
    QUESTION #83: Topic: Reporting Revised IMRT Plan

    We are treating a patient on our Tomotherapy machine. This patient is about mid way through their prescribed course. The physician has made a change to one of the volumes and the whole course had to be re-planned. Is there a planning charge we can submit for reimbursement for services rendered? We have already charged a 77301. I know what the literature states but we were wondering if there is another avenue we can go down to receive payment for services.

    NEWSLETTER: July-August 2008, Volume #5, Issue 82

       
    QUESTION #84: Topic: SBRT Exceeds 5-Fractions

    We have a SBRT patient that will require seven treatment days. The patient has two separate lung lesions. One lesion is prescribed three fractions; the other lesion is prescribed four fractions. Due to the length of treatment time for each lesion, only one lesion will be treated per day. Therefore, seven SBRT treatments will be required. How should we bill this SBRT course?

    NEWSLETTER: July-August 2008, Volume #5, Issue 82

       
    QUESTION #85: Topic: Nurse Practitioner or Resident Reporting Weekly Management

    When a resident or nurse practitioner sees the patient on the weekly visit in conjunction with the MD, how should the dictation read?

    NEWSLETTER: July-August 2008, Volume #5, Issue 82

       
    QUESTION #86: Topic: Image Fusion

    Please advise me on what are the appropriate codes to charge for fusion. Our new dosimetrist feels we are missing some charges - currently we only charge 77370. Any advice you can give will be appreciated.

    NEWSLETTER: July-August 2008, Volume #5, Issue 82

       
    QUESTION #87: Topic: MU Quantity – Field in Field

    What are the proper dosimetry charges for a field-in-field breast plan? In a case that we have a plan with bolus and one without, do we charge for each?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #88: Topic: Simulation for Revised Plan

    When the patient has a plan that cannot be implemented, and a new plan is done, is it appropriate to bill for any other services that may have to be re-done such as a CT sim?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #89: Topic: Initial Plan Not Used

    A plan has been performed, approved by the physician and then billed. When the patient comes in they cannot tolerate the positioning and have to be re-planned. Is that initial plan billable?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #90: Topic: Machine Down MU

    What is billable if a machine goes down and the patient has to be re-planned on another machine?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #91: Topic: Room Charge

    We have been unsuccessful in obtaining a payable Medicare CPT code that represents our oncology consults since January. Should we consider stop charging the consults at the hospital technical level?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #92: Topic: Edit for 77336 & 77370

    I have a Quadex error on 77336-59 and 77370 on the same date. Can you tell me what the problem is with this combination?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #93: Topic: CCI Edits 77432 & 77470

    We are told that there is an edit for 77470 and 77432, but I do not see a CCI edit for this. Is this true?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #94: Topic: Fusion

    Currently we charge 77370 for all fusion cases, regardless of physics staff intervention. Is this correct? When can we charge 77470 for fusion?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #95: Topic: DOS for 77336

    Does this Physics chart check code date of service (DOS) need to be reported on the date that the check is done or may it be reported once every five treatments? Example: Chart check is done after treatment 6 and then after treatment 10, four days later. Should we code after the sixth treatment and then after the tenth treatment, or can we code on the 5th and 10th?

    NEWSLETTER: June 2008, Volume #4, Issue 81

       
    QUESTION #96: Topic: 77014

    Please clarify when the professional component of code 77014 is reported

    NEWSLETTER: April-May 2008, Volume #3, Issue 80

       
    QUESTION #97: Topic: Urologist Coding

    During a prostate seed implant, the urologist and oncologist work together to place the needles. Can they both report code 55875? If yes, is a modifier required?

    NEWSLETTER: February 2008, Volume #2, Issue 79

       
    QUESTION #98: Topic: Brachytherapy Planning

    When we are doing a 3D plan [77295] for brachytherapy, can we also charge for the CT data acquisition [77014] and the complex simulation code [77290]? If yes, what about the Edits.

    NEWSLETTER: February 2008, Volume #2, Issue 79

       
    QUESTION #99: Topic: Virtual Simulation for Electrons

    Patient has simulation done on a dedicated CT simulator for chest-wall irradiation. We bill 77014 and a 77290 on the first day. Dosimetry then plans the tangents, supraclav and IMC. Codes 77315, 77300s, and 77334 are billed. When the physician reviews the plan (during the planning process), the physician has dosimetry add an electron field to IMC for accurate dose. The patient is treated with photons to IMC, electrons to follow to IMC. The question is can you bill a virtual simulation for the electron or is it included in the CT sim?

    NEWSLETTER: January 2008, Volume #1, Issue 78

       
    QUESTION #100: Topic: MammoSite Balloon Removal

    I know that the charge for removing the balloon catheter for MammoSite patients is included in the surgeon's insertion fee. However, would it be appropriate to charge under code 77799 if the radiation oncologist removed it, instead of sending the patient back to the surgeon for removal?

    NEWSLETTER: January 2008, Volume #1, Issue 78

       
    QUESTION #200701: In the recent past we had to send our CT images to radiology for a limited read (per contract) by the radiologists. Their group had an audit performed and it was concluded that they would no longer be providing a limited read for our CT images. My questions are as follows: 1. Can we (radiation oncology) charge for a 77014? 2. What documentation is needed to charge the pro fee?

    NEWSLETTER: February-March 2007 Newsletter Volume 2, Issue 71

       
    QUESTION #200702: Can a simple device be coded for the placement of a vaginal cylinder for each HDR procedure?

    NEWSLETTER: April 2007 Newsletter Volume 3, Issue 72

       
    QUESTION #200703: We typically bill clinical treatment planning on a day after the E & M service but before the simulation process. The date of service is always the date it is documented based upon a dictated planning note that defines the area to be treated, the prescribed fractionation and protocols to be followed. Often our documentation includes special services ordered, i.e., diodes, off axis calculations, requests for special physics consults, planned additional studies and planned reductions, etc. Question: What is the correct billing disposition when clinical treatment planning is developed, documented and billed in good faith only to discover that the patient subsequently declined treatment?

    NEWSLETTER: April 2007 Newsletter Volume 3, Issue 72

       
    QUESTION #200704: Is it appropriate to report 77373 or any stereotactic code for linac based stereotactic courses (intracranial or extracranial) that are greater than five fractions? Is there a professional component reported for 77373?

    NEWSLETTER: April 2007 Newsletter Volume 3, Issue 72

       
    QUESTION #200705: A center in xxx is successfully billing twice for all calc checks (77300) on the basis that one is performed by the dosimetrist using the treatment planning system and the other is performed by the physicist using an independent check system (i.e., RadCalc). My question is; for 3D conformal planning, can you bill 77300 twice, once for a calculation performed by treatment plan and once for a calc done by an independent check system?

    NEWSLETTER: May-June 2007 Newsletter Volume 4, Issue 73

       
    QUESTION #200706: We are a freestanding center and were advised to report a complex device for the design of a block when the DRR is printed and to report a second device when the MLC are programmed. Is that correct?

    NEWSLETTER: May-June 2007 Newsletter Volume 4, Issue 73

       
    QUESTION #200707: We are confirming the placement of the MammoSite balloon on our dedicated CT simulator. We are reporting a simple simulation (77280) and 77014-TC. Is that correct?

    NEWSLETTER: May-June 2007 Newsletter Volume 4, Issue 73

       
    QUESTION #200801: Topic: MammoSite Balloon Removal

    I know that the charge for removing the balloon catheter for MammoSite patients is included in the surgeon's insertion fee. However, would it be appropriate to charge under code 77799 if the radiation oncologist removed it, instead of sending the patient back to the surgeon for removal?

    NEWSLETTER: January 2008, Volume #1, Issue 78

       
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