By Jessica Adams, ASTRO Health Policy Analyst
In addition to providing resources to assist practices in submitting accurate claims for reimbursement, ASTRO is actively engaged in working with payers on coverage and payment issues. Recently, we received feedback from payer entities about receiving incorrectly billed claims. ASTRO has compiled the following Reimbursement Reminders from our many Coding
resources to help practices address these issues.
The following are the top five coding errors that payers receive from radiation oncology practices. Avoid these coding “don’ts” to expedite payer approval and payment.
1. Simulation codes 77280-77290 are billed (and appealed) for initial simulation prior to intensity-modulated radiation treatment (IMRT) planning code 77301.
Payers have received claims that bill simulation codes 77280-77290 for an initial simulation prior to or during IMRT Treatment Planning 77301. Effective January 2017, CMS updated the CPT codes that may be reported with the development of an IMRT treatment plan. ASTRO’s IMRT Planning Coding Guidance
explains that CPT codes 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77321 and 77331, are included in the payment for CPT code 77301 (IMRT planning) and should not be reported in addition to 77301 when provided prior to or as part of the development of the IMRT plan.
Additionally, CPT code 77280 Simulation Aided Field Setting should not be reported for verification of the treatment field during the course of IMRT.
For information on what ASTRO believes to be correct coverage for IMRT services, see ASTRO’s IMRT Model Policy
2. Inappropriate stereotactic radiosurgery (SRS) billing for brain lesions.
Payers have reported that some claims bill individual episodes of SRS to each brain lesion, instead of treating all brain lesions in a 1-5 fraction course of SRS. ASTRO’s SRS Model Policy
delineates SRS-specific guidelines. When billing SRS for multiple brain lesions, CPT code 77373 is most appropriate. The full 77373 description reads, “SBRT, or stereotactic cranial radiosurgery 2-5 fractions-treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions.”
For a more detailed review of clinical indications, see ASTRO’s SRS Model Policy
3. Billing for the technical component of image-guided radiation therapy (IGRT) with IMRT treatment delivery codes 77385 and 77386.
Other claims bill the technical component of IGRT with IMRT treatment delivery codes 77385 and 77386. ASTRO’s IGRT Coding Guidance
(see the third coding question) explains that IMRT treatment delivery codes 77385 and 77386 include guidance and tracking, when performed. The technical component (TC) of IGRT (77387-TC) is packaged into the IMRT service with which it is performed and should not be reported separately in either the freestanding or hospital setting. The professional component (PC) of IGRT can still be reported.
For additional details on IGRT, read the entire Coding Guidance
4. Port films, IGRT codes and/or simulation codes and SRS/SBRT treatment delivery are reported for each session.
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.
ASTRO’s 2018 Coding Resource
discusses proper billing of these services. Per the Resource, “According to Medicare policy, portal verification films may be reported as one charge per five fractions of therapy, regardless of the number of images required during this time interval, as long as at least one film was taken” (page 64).
5. Multiple imaging techniques (port films, IGRT and verification simulations) reported at the same patient encounter on the same date of service.
Another coding issue arises when practices report multiple imaging techniques, such as port films (CPT 77417), IGRT (CPT 77387, 77014, G6001, G6002, G6017) and simulation (CPT 77280, 77285, 77290, +77293) for the same patient encounter on the same date of service.
ASTRO’s IGRT Coding Guidance
(see the first coding question) explains that, “Medicare payment policy stipulates that the professional interpretation of port images is part of weekly treatment management (CPT code 77427). However, the technical component is reportable using CPT code 77417 as one charge per five fractions of therapy per gantry angle.”
Additionally, ASTRO’s 2018 Coding Resource
states that “CPT code 77014 (CT guidance) was packaged into the simulation codes and is no longer separately reportable in either the freestanding or hospital-based setting” (page 42).
We hope that this guidance helps radiation oncology practices as they navigate billing issues. Do you have billing questions or any other common billing pitfalls? Let us know in the comments.
To purchase ASTRO’s Coding Resource, which includes information on updated CPT codes effective January 1, 2018, visit our website
. Or, if you’ve already purchased the Resource, you may access it by logging in to your MyASTRO
account and clicking on Virtual Meetings/Products under My Resources.
For in-depth, in-person training on coding issues, be sure to register for ASTRO’s 2018 Coding and Coverage Seminar
, taking place March 23-24 at ASTRO’s Arlington, Virginia headquarters. Space is limited, so register today
ASTRO supports the workshop with an educational grant. This funding from ASTRO provides for radiation oncology education, covering expenses such as tuition, travel expenses and accommodations for residents and faculty members. Radiation oncologists, including Christopher Willett, MD, FASTRO, Joel Tepper, MD, FASTRO, and Stephen Hahn, MD, FASTRO, have participated as faculty members at past workshops.
Resident radiation oncologists, like Noelle Williams, MD, have been reaping the rewards of this program for many years. Dr. Williams, who is Chief Radiation Oncology Resident at the Thomas Jefferson University, received the distinguished Daniel D. Von Hoff Innovative Protocol Award for her outstanding work during the Vail Course in 2017. This award is selected by the faculty-at-large and is awarded to the best protocol developed at the meeting. Her experience there reflects the tremendous opportunity and impact of this course:
“The Vail Methods in Clinical Cancer Research Workshop was truly an amazing experience, and one of the most educational weeks of my entire residency. I would recommend this course to anyone with an interest in effective clinical trial design and implementation.”
According to Dr. Williams, one of the key components to the course, in addition to the in-depth materials provided, is the mentorship. “The mentorship is one of a kind, and one of the highlights of the course is the low trainee-to-faculty ratio. During the week, I was able to connect with leaders in multiple fields who have a true interest in helping attendees to perfect their protocols.”
Radiation oncologists have participated in the past, but as more combination radiation-chemotherapy or radiation-immunotherapy trials are underway, it is more critical now than ever before for radiation oncologists to actively engage in the development and execution of these trials.
What is the benefit for radiation oncologists? Dr. Williams posits that it is the networking opportunities. “The ability to network with trainees and experts across all fields, including surgical oncology, biostatistics and medical oncology, is one of the highlights of the course.”
Applications are being accepted through March 12. Visit the website
for more information and to apply.
By Najeeb Mohideen, MD, FASTRO
ASTRO hosted its first two-day Coding and Coverage Seminar at ASTRO headquarters in December 2017
to a sold-out crowd. Attendees of the Coding and Coverage seminar included professional coders and billers, practice administrators, radiation oncologists and representatives from private payers. The intimate setting—registration was capped at 50—allowed for a Socratic, interactive event. Attendees had direct access to ASTRO faculty and staff, and feedback from attendees largely emphasized how impressed they were with the ease with which they could have their questions answered.
Being a conference moderator at the December seminar was quite an exhilarating experience. Reviewing the scores of questions that were being sent in real-time gave me a unique insight into the major coding and reimbursement issues that our clinicians face every working day. The ASTRO faculty involved in the seminar included subject-matter experts who are also adept at health policy, so many of the attendees—especially the radiation oncology clinical staff—enjoyed being able to engage in conversations and interact with staff on coding issues, with a heavy emphasis on the clinical process of care.
Going by the feedback, participants found the seminar highly worthwhile. A typical comment was: “We found several opportunities for improvement and correcting our current process.” Another said: “It was great discussing coding with the folks who actually developed these codes.”
Attendee survey results reflect these comments. Seventy-six percent of attendees reported that they would be making changes in their current practice based on information they learned at the seminar, and 93 percent of attendees reported feeling prepared for coding and coverage issues that will arise in their practice as a result of attending the meeting.
Faculty at the December Coding and Coverage Seminar included those who write the annual ASTRO Coding Resource
, and those who are directly involved in health policy and ASTRO’s advocacy efforts. The seminar is a wonderful way to not only understand how to correctly use the CPT codes for radiation oncology, but also to understand some background information on the process of code development. Changes specific to the 2018 CPT code set were also discussed, and attendees were able to ask questions and gain clarity on this complex subject. Faculty of the Coding and Coverage Seminar were thrilled to be able to provide coding and coverage information pertaining specifically to radiation oncology to the attendees.
Coverage issues within radiation oncology were discussed during the two-day event, as well, and attendees gained insight into coverage topics and trends that have arisen over the past year. ASTRO staff provided updates on ASTRO’s efforts to address coverage issues experienced by members, and were available to talk to attendees about individual issues they had seen at their practices.
Additional topics covered at the seminar included sessions on the Quality Payment Program and specific modalities, such as intensity-modulated radiation therapy (IMRT), brachytherapy, proton beam therapy (PBT) and stereotactic radiosurgery (SRS)/stereotactic body radiation therapy (SBRT). Case studies were also presented to help attendees learn how to apply their newfound coding knowledge.
The response to the first Coding and Coverage Seminar was overwhelmingly positive. “Many staff get early training and limited resources” for coding education, according to one attendee. “Between cross coverage of billing for different specialties and varied education about radiation oncology coding, this course would be a valuable tool to many staff to get it right and understand some of the background behind each code. I personally found it helpful to correctly guide billing for our expanded capabilities and services.”
Due to popular demand, another Coding and Coverage Seminar will be held at ASTRO headquarters on March 23-24 in Arlington, Virginia.
This will be the last Coding and Coverage Seminar addressing the coding and coverage changes of 2018. To maintain the small-group setting, registration is limited, and the event is expected to fill quickly. Registration for the March Coding and Coverage Seminar comes with both electronic and printed editions of the 2018 ASTRO Coding Resource
, and if you are interested in attending, it is recommended that you register now.
Do you have questions regarding to the 2018 CPT codes? Let us know in the comments and we can pass them along to ASTRO coding staff members.