Question: Texas Subscriber Answer: TrailBlazer, the Medicare Administrative Contractor (MAC) for Texas, has a local coverage determination (LCD) stating you must prove medical necessity to code both: "Medicare would not expect to see providers billing frequently for the design and construction of devices that are separate and distinct from the 'device' derived from the computerized IMRT plan. The Correct Coding Initiative (CCI) bundles the device codes 77332-77334 into 77301. In cases where these separate devices are billed, the medical record must clearly demonstrate the medical necessity and rationale for the service" ("Intensity-Modulated Radiation Therapy (IMRT)," 4R-22AB, available at www.trailblazerhealth.com). Another example: Remember to append modifier 59 (Distinct procedural service) -- but only if the medical record has documentation to support modifier 59 use. The clarification warns that you should not report IMRT planning and treatment device codes on separate days simply to avoid the bundle. (Locate the article "IMRT Plan 77301:NCCI Edit Clarification" by searching for document ID "A39731" at www.cms.hhs.gov/mcd/search.asp). Caution: -- Technical and coding advice for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Los Angeles-based Sinaiko Healthcare Consulting.