Oncology & Hematology Coding Alert

Question: We're having a debate about whether we may report the professional component of 77334 for IMRT patients. Is there any authoritative guidance? Texas Subscriber Answer: You typically should not report device codes 77332-77334 (Treatment devices, design and construction ...) in addition to IMRT planning (77301, Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications). 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 [...]