Coding Question: When an emergency patient starts treatment on the same day of the first visit, how can the IMRT plan, simulation, and IMRT treatment be billed on the same day?
Coding Answer: The necessity for generation of an IMRT plan in an emergent setting would be unusual. However, a new patient visit (99202-99205) or an established patient visit (99212-99215) may be billed on the same day as an IMRT plan (77301) with a -59 modifier (distinct procedural service) if medically justified. Reimbursement for simulation (77280-77290) is bundled into the payment for IMRT planning (77301) and is therefore not separately reimbursed. There are no PTP edits between IMRT planning (77301) and IMRT delivery (G6015, G6016, 77385, or 77386) and so both planning and delivery may be reported for the same date of service.
Coding Question: CPT® codes for reporting a teletherapy isodose plan (77306-77307) or a brachytherapy isodose plan (77316-77318) states that Basic Radiation Dosimetry (77300) is bundled into these codes. Has there been any bundling of 77300 for IMRT planning (77301) and 3-D planning (77295)? Also, can we bill 77300 with Special Teletherapy Port Plan (77321)?
Coding Answer: CPT code 77300 is not bundled into either 77301 or 77295 and can still be reported with these codes. If a particle beam is planned for delivery without an isodose plan (77321, 77306 or 77307), then CPT code 77300 can still be reported. CPT 77300 should not be reported with 77321. If the particle beam plan rises to the level of 77295 or 77301, CPT code 77300 can be utilized.
Coding Question: When a patient presents with distinct disease sites that require different immobilizations devices and/or CT simulations performed on the same day which possibly require different treatment techniques (e.g., SRS and IMRT) can we submit simulation and planning charges for each site separately?
Coding Answer: If multiple and distinct treatment sites are simulated on the same date of service, then only one simulation charge and one dosimetric treatment planning charge may be reported for all treatment sites (please note that simulation is bundled into IMRT planning and is therefore not separately reportable). However, immobilization devices may be reported for each distinct treatment site.
Coding Question: If a patient is planned and treated with multiple modalities, e.g., IMRT and electrons or IMRT and protons, can charges be submitted for each plan if they are based on the same CT? Does it matter if the planned targets are the same (e.g., both modalities targeting the PTV) or different (one modality targeting the PTV and the other the GTV)?
Coding Answer: If a single CT dataset is used to generate multiple treatment plans using different modalities and/or targets and if one plan is an IMRT plan, then only one unit of 77301 (IMRT planning) may be reported regardless of the number of planning targets or modalities. If clinically indicated, a second CT dataset may be obtained for boost planning, and a separate treatment planning charge may then be submitted.
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®) 2022, American Medical Association. All Rights Reserved.
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