ASTRO Shapes the Top Five Reimbursement Errors, According to Payers

Reminders (RORR) lion for important coding information from ASTRO.
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 and Reimbursement 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.

Posted: February 28, 2018 | with 0 comments

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