November 2006
Appropriate billing for brachytherapy sources for freestanding versus hospital outpatient departments. 

When billing for radioactive sources in hospital based departments the appropriate C code should be utilized.  A sample of commonly utilized C codes are: C1716 Brachytx source, Gold 198, C1717 Brachytx source, HDR Ir-192, C1718 Iodine 125, C1719 Brachtx source Non-HDR Ir 192, C1720 Brachytx source, Palladium 103.  Don’t forget any needles or catheters that may be utilized:  C1715 Brachytherapy Needle & C1728 Cath brachytx seed administration.  While there currently is no APC payment rate for these needles or catheters they do need to be reported.  

When billing for these radioactive sources for freestanding centers or ASC the Q3001 Radioelements for brachytherapy, any type must be utilized.  You may find that this Q3001 may also have to be used in the hospital setting IF a commercial carrier denies the appropriate C code. 

Don’t forget to bill these in the number of units documented in the medical record.

Sally Eggleston, MBA, R.T. (T)
Director of Business Development
Revenue Cycle Inc.
www.revenuecycleinc.com  

April 2006
When reviewing the CCI/OCE edits for IMRT Treatment Planning you will find the following:

OPEN SPREADSHEET

Column 1 represents the 77301 IMRT Planning code while Column 2 has other radiation oncology CPT codes represented.  Column 6 lets us know whether or not the procedure code in Column 2 can be billed on the same date of service as the 77301 IMRT Planning.  A 0 lets us know that this cannot be done while A1 does allow billing this additional code if performed & documented with the appropriate modifier added.  
Modifier usage does vary across the country from carrier to carrier as well as fiscal intermediary to fiscal intermediary so determining the appropriate modifier can be tricky.  These CCI/OCE edits are currently same date of service edits and should not effect billing other codes on different dates of service as long as medically necessary, ordered, performed and documented.

Sally Eggleston, MBA, R.T. (T)
Director of Business Development
Revenue Cycle Inc.
www.revenuecycleinc.com

January 2006
3 very important tips to consider when billing and coding for IMRT treatments and IMRT planning. 

1.      Ensure that you are coding the treatment delivery correctly; 77418 for dynamic and binary MLC and 0073T for compensator based IMRT.

2.      Medical necessity is an important issue that should be addressed on each and every IMRT patient.  The majority of  LCD’s outline what criteria must be met in order to perform and bill for IMRT over conformal therapy.  This medical necessity statement must come from the physician and be in writing in the medical record. 

3.      Printing of fluence maps will establish documentation for the treatment devices (77334) that may be billed.  The print date of these fluence maps should correspond with the date of billing. 

Sally Eggleston, MBA, R.T. (T)
Director of Business Development
Revenue Cycle Inc.
www.revenuecycleinc.com

November 2005
New procedure code for 2006: 77421 Stereoscopic x-ray guidance

October 2005
Continuing Physics, Port Film and Weekly Management Billing Clarification: 77336, 77417, 77427

When billing to Part B in a global setting different Medicare Carriers have different regulations on how to bill these procedures.  Commercial carriers may want these procedure codes billed different than Medicare.  Noridian Medicare, for example, is requiring providers to bill not only the 77427 Weekly Management within the following requirements, but also 77336 Weekly Physics Check and 77417 Port Films: 

1)                 Item 24a on the CMS 1500 claim form should include either the date span, the initial date, or the final date of the five fractions billed.  The services need not be furnished on consecutive days, but must be reported with no overlapping in dates of service as a span of dates.

2)                 The associated number of fractions delivered needs to be reported in Item 19 on the CMS 1500 claim form or the electronic equivalent.  

These differences by carriers are why it is important to check your state’s carrier guidelines as well as your commercial carriers for instructions on billing all three of these codes.  

Sally Eggleston, MBA, R.T. (T)
Director of Business Development
Revenue Cycle Inc.
www.revenuecycleinc.com

September 2005
Effective January 1^st, 2005 procedure code 79900 was deleted and HCPCS Code Q3001 should be used by providers on claims when billing for radioelements for brachytherapy performed in an ASC setting.  The HCPCS Q3001 is priced for carriers on the 2005 Medicare Physicians Fee Schedule and should be utilized for prostate brachytherapy procedures when performed in ASC setting.  There has been confusion among ASC’s as well as Carriers on this change in procedure coding so be aware and observant for proper reimbursement.