Oncology & Hematology Coding Alert

Reader Question:

CT Scan Guidance

Published on Sun Jul 01, 2001

Question: When is it appropriate to bill 76370 for CT scan guidance for radiation treatment planning? Also, Medicare recognizes modifier -26, which pays about $45. Can we charge this fee if the CT scan is ultimately used for a 3-D simulation, 77295? What documentation of service is required and are there any restrictions?

Maryland Subscriber

Answer: Whenever a CT scan is required to get tumor specifications for radiation therapy planning, it is appropriate to bill 76370 (computerized tomography guidance for placement of radiation therapy fields). A 3-D CT simulation, 77295, produces a computer-generated 3-D reconstruction of tumor volume and surrounding critical normal tissue structures from direct CT scans and/or MRI data in preparation for non-coplanar or coplanar therapy. If the CT scan is used and the 3-D simulation performed, bill both codes. Remember, if you use 3-D simulation, you cannot bill for treatment planning because it is included in the computerized simulation.

The CT scan, as with many other radiological exams, consists of a technical charge that includes the radiologist's report. So, there is no reason to bill modifier -26, which designates professional component only.

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