Oncology & Hematology Coding Alert

Question: My coworker says we can bill intensity modulated radiotherapy (IMRT) calculations on the same day as the plan. I've always billed it on a separate, subsequent day. Who's right?

Virginia Subscriber

Answer: It depends. You would typically bill these codes on different dates of service, but not always.

First, remember that to bill CPT^® code 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) separately from 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications), the calculation must be a separate and distinct service, prescribed by the treating physician, beyond those that are a part of the IMRT plan. You may not report this service for the computerized IMRT plan, or films, phantoms, or equivalent done as a part of the plan.

You can bill 77300 on the same day as 77301, but only if the QA was also done on the same day. This is "a very subtle point that gets missed," says Ron DiGiaimo, MBA, president of Revenue Cycle Inc. If you're doing the plan on Monday, and the QA on Tuesday, you'd bill the calculations on Tuesday along with the QA. If you do the plan on Monday, and the QA is done later that day, you can bill everything on Monday.

"Realize that the reason you're billing [calculations] on the same day is the second checks, not the plan," emphasizes DiGiaimo. If you bill the calculations on the same day as the plan, without the QA having been done, you'll get denied. Your coworker is right, but perhaps doesn't know exactly why.