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Daily Practice

IGRT

Coding Question: What is the official policy on 77417-26 port images? 

Coding Response: 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 in the physician office/freestanding setting using CPT code 77417 as one charge per five fractions of therapy per gantry angle. No modifier is required for these services.
 

Coding Question: How do you document IGRT? Is it sufficient to just electronically sign off on the orthogonal images or CBCT for IGRT? I have heard that a daily note is also needed? Do you write a unique daily note to support 77387?

Coding Response: The images and shifts are to be reviewed and approved by the radiation oncologist prior to the patient’s next treatment. Appropriate documentation could be a note in the patient’s chart or a physician’s electronic signature on the shifts/images. A unique daily note is not required.
 

Coding Question: How do we report image guidance with IMRT using the CPT and G codes that went into effect in 2015?

Coding Answer: Beginning in 2015, Medicare bifurcated IMRT treatment delivery reporting and instructed providers to use codes 77385 and 77386 in the hospital outpatient setting and G6015 and G6016 in the freestanding setting. Medicare payment for codes 77385 and 77386 also packages payment for the technical component for guidance and tracking, whereas no payment for guidance and tracking is included in payments for G6015 and G6016. Regarding guidance and tracking reporting, Medicare introduced codes 77387, G6001 and G6002 in 2015 while preserving code 77014. These guidance codes consist of technical and professional components and may be reported according to practice setting as described below. Please note that code 77387 did not receive a value in the Medicare Physician Fee Schedule (MPFS) in 2015.


 

IGRT Reporting in the Freestanding Setting

IGRT Reporting in the Hospital Setting

IGRT with IMRT Delivery

Office bills:

  • IMRT code: G6015 or G6016
  • IGRT code: G6001, G6002 and/or 77014 (global)

Hospital bills:

  • IMRT code: 77385 or 77386

Physician bills:

  • IGRT code(s): G6001, G6002, and/or 77014 with the -26 modifier attached (PC)

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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