IGRT

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

Coding Response: Historically, portal images were acquired using X-ray film, for which modern electronic portal imaging technology may substitute. Port image verification is a technical component-only procedure and does not carry a professional physician component. Medicare payment policy stipulates that the professional interpretation of port images is part of weekly treatment management (CPT code 77427). However, the technical component (i.e., the costs associated with generating port images) is reportable in the non-facility or physician office/freestanding setting using CPT code 77417. No modifier is required for these services. Per Medicare policy, portal verification images may be reported as one charge per five fractions, regardless of the number of images acquired during this time interval, provided at least one image is taken.

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: Can a physician review and electronically sign-off on IGRT images if the physician was not in the facility on the day the imaging was performed? (Example: A physician is out on Friday and returns to work on Monday and reviews IGRT images from that Friday prior to the next scheduled treatments)

Coding Response: To meet the criteria for billing the PC of IGRT, a radiation oncologist must review and approve the IGRT data prior to the next treatment session. The PC work does not need to be completed on-site where the delivery was furnished, however if the PC work is performed off-site, the site of service will remain with the on-site location. As for billing the TC of IGRT, CMS designates that image guidance requires the direct supervision of a physician (on-site and able to furnish assistance if necesssary) in both freestanding and hospital settings. The billing system will need to be set up to separate the PC and TC and assign them to the appropriate physicians. If your billing system cannot separately assign the TC and PC components to the appropriate physician, then this may not be feasible in your practice setting.  You should consult your compliance office before making a change in your billing pattern.

Coding Question: How do we report image guidance with IMRT and Conventional treatment 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 image guidance and tracking reporting, Medicare introduced codes 77387 (IGRT), G6001(ultrasound) and G6002 (stereoscopic) in 2015 while preserving code 77014 (CT). 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.

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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