Wiki 77301-Radiation Oncology

Create Wiki
S

sidney01@roadrunner.com

Contributor
Messages
19
Location
Huntington, WV
Best answers
0
We have recently started getting edits/denials stating "A code is present that should not be reported on the same claim as 77301 (Intensity Modulated Radiotherapy planning). When we inquire, 77293 comes in the discussion as well as 77014 and 77370. We found where there are exceptions to 77370 if we provide proper documentation. We cannot find anything that would cause these to edit out, especially with 77293 as this IS AN add on code to 77301? Has anyone else seen an increase of these edits/denials with 77301? I saw where changes were made 07-01 with the New NCCI edits for Add on codes. I cannot find anything that would pertain to this?
 
sidney01@roadrunner.com said:
We have recently started getting edits/denials stating "A code is present that should not be reported on the same claim as 77301 (Intensity Modulated Radiotherapy planning). When we inquire, 77293 comes in the discussion as well as 77014 and 77370. We found where there are exceptions to 77370 if we provide proper documentation. We cannot find anything that would cause these to edit out, especially with 77293 as this IS AN add on code to 77301? Has anyone else seen an increase of these edits/denials with 77301? I saw where changes were made 07-01 with the New NCCI edits for Add on codes. I cannot find anything that would pertain to this?
Click to expand...

Are you billing for the facility or the physician?
 
If you're billing for the the facility, there is CMS OPPS guidance for 77301. Remember this guidance applies even if you are billing them on different DOS!

200.3.1 - Billing Instructions for IMRT Planning and Delivery (Rev. 3685, Issued: 12-22-16, Effective: 01-01-17, Implementation: 01-03-17) Payment for the services identified by CPT codes 77014, 77280, 77285, 77290, 77295, 77306 through 77321, 77331, and 77370 are included in the APC payment for CPT code 77301 (IMRT planning). These codes should not be reported in addition to CPT code 77301 when provided prior to or as part of the development of the IMRT plan. In addition, CPT codes 77280-77290 (simulation-aided field settings) should not be reported for verification of the treatment field during a course of IMRT.


(edited to fix link - my google chrome has been difficult with pdf links recently)
 
You must log in or register to reply here.
Top