Oncology & Hematology Coding Alert

Question: The radiation oncologist whom we do billing for is considering the purchase of his own CT scanner. He will be using it to aid in preparation for his simulations. It will not be used for diagnostics. Can you give me some advice on billing and good chart documentation?

Georgia Subscriber

Answer: According to CPT Assistant (Fall 1991), CPT code 76370 (computerized tomography guidance for placement of radiation therapy fields) designates a treatment planning CT to localize the treatment portals. Provided that you bill for a free-standing center, the technical component of the CT scan may be reported by the center using CPT code 76370-TC (or whatever technical component indicator is required by your specific payers).

Generally, the CT slices are obtained for use in a three-dimensional planning system, and a separate interpretation and report is not performed. Therefore, there is no professional service to bill.

If the CT equipment is located on hospital premises, the physician generally cannot bill for the technical component of the service unless:

1) She or he owns or leases the equipment at fair market value;
2) She or he owns or leases the space at fair market value; and
3) She or he employs the technician(s) in an arrangement that satisfies the Internal Revenue Service employer/employee-relationship definition.

There are exceptions to these guidelines for certain joint ventures and similar arrangements. If the physician is contemplating purchasing equipment for use in a hospital, he or she should consult healthcare carriers.