Daily Practice

Treatment Delivery

Coding Question: Can a physician bill anything besides an Evaluation and Management (E/M) code with superficial radiation therapy (77401)?

Coding Answer: The following codes cannot be reported with 77401 as of January 1, 2015, regardless of whether your payer accepts the new CPT codes or the G-codes: clinical treatment planning (77261, 77262, 77263), treatment devices (77332, 77333, 77334), isodose planning (77306, 77307, 77316, 77317, 77318), physics consultation (77336), or radiation treatment management (77427, 77431, 77432, 77435, 77469, 77470, and 77499). There are no exclusions against reporting simulation codes (77280-77290) or basic dosimetry calculation (77300) with 77401; however, these codes may only be performed and reported when clinically indicated and appropriately documented. E/M codes may only be reported with 77401 when reporting 77401 alone.

Coding Question: When do we charge by energy when using the conventional radiation therapy treatment delivery codes (using the G-codes), and when do we use the new single energy CPT codes (77402, 77407, 77412)?

Coding Answer: The G-codes (G6003-G6014) assigned to the deleted conventional radiation therapy treatment delivery CPT codes (77402-77416) should be used to report treatment delivery under the Medicare Physician Fee Schedule in the freestanding office setting. Medicare payers and many private payers will accept G-codes. The new CPT treatment delivery codes should be reported in hospital based settings under the HOPPS.