Oncology & Hematology Coding Alert

Question: For an oncologist working in a hospital, how should I code a complex block, specially made wedge, and mask for one port?


Indiana Subscriber

Answer: Because the hospital covers the technical portion of the code, you should append modifier 26 (Professional component) to the code for the complex design (77334, Treatment devices, design and construction; complex [irregular blocks, special shields, compensators, wedges, molds, or casts]). Your payer may allow you to report 77334 three times for your scenario--once for the immobilization device and once for each of the custom-made devices.

Immobilization devices: Most Medicare policies state: -Custom-made immobilization devices should be billed at a complex level (CPT code 77334).- You may charge the immobilization device regardless of whether or not there are beam-shaping devices. If you have multiple immobilization devices, the payer generally reimburses only one of them.

Beam attenuation devices: Carriers typically hold that -when the patient has a combination of a wedge, a compensator, a bolus, or a port block covering the same treatment port, this would be billed as a single complex treatment device charge rather than a separate charge rendered for each of the individual items. If devices of two separate levels of complexity are utilized for the same treatment port, only the one of the highest complexity will be billable.- This is a -package block---multiple devices used for the same treatment port charged as a single complex device.

Exception: If the physician constructs each device independently, then you may code for each if your documentation clearly shows individual fabrication of each device.