Oncology & Hematology Coding Alert

Question: I know that simulations cannot be billed on same DOS as E/M codes, unless of course separate and significant. However, I’m not finding a clear answer regarding billing IMRT planning 77301 on same DOS as an E/M code. My thought is no. However, our doctors are requesting documentation, and for some reason, I’m not finding a resource specifically addressing this situation. Do you have any information about this?

AAPC Forum Participant

Answer: As with simulations, you should not report an E/M service on the same service date as IMRT planning (77301, Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications). Per Medicare and Medicaid National Correct Coding Initiative (NCCI) edit rule for standards of medical / surgical practice, the E/M service is a column 2 code for the IMRT planning service. It does indicate a modifier may be used to override the edit under appropriate circumstances.