Oncology & Hematology Coding Alert

Question: I am in the middle of a debate where I work. My intensity modulated radiation therapy (IMRT) treatments are getting denied because the therapists and providers keep charging 77014 with them for the cone-beam computed tomography (CT). Can we bill just the professional component of 77014 with IMRT?

AAPC Forum Participant

Answer: You are correct in that not only can you bill 77014 (Computed tomography guidance for placement of radiation therapy fields) along with 77385 (Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple) or 77386 (… complex), but you can also bill the professional component of IMRT CT guidance by appending modifier 26 (Professional component) to 77014.

Per CPT^® Assistant Volume 26, Issue 2 (February 2016), in “both the hospital and freestanding settings … CPT^® code 77014 … with modifier 26 appended, may … be used to report the physician work in CT guidance.” Whoever owns the equipment cannot bill the technical component, however, because it is bundled with the services associated with 77385 and 77386.

The same CPT^® Assistant article also tells you many payers also accept HCPCS Level II codes G6001 (Ultrasonic guidance for placement of radiation therapy fields) or G6002 (Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy) “to report the physician work of image guidance with conventional radiation therapy treatment delivery.”