The biggest billing buzz in Radiation Oncology for the last two weeks is about the bundling of code 77290 (Therapeutic radiology simulation-aided field setting; complex) with code 77301 (Intensity modulated radiation therapy plan).

For years rad/onc billers have followed the guideline that the simulation is preformed prior to the treatment planning, therefore is a billable separate service. 

 

CMS however has put into effect an edit that bundles code 77290 billed anytime during an IMRT treatment course. 

 

The logic is that the RVUs for code 77301 has been adjusted to include the “work” associated with the patient planning simulation.

 

The concept of this code being bundled in is not unique in radiation oncology.  Similar examples are:

 Code 77295 (Three-dimensional radiotherapy plan) included work performed by code 77315 (Teletherapy isodose plan).

Codes 77306 and 77307 (Teletherapy isodose plan) includes work performed by code 77300 (Basic radiation dosimetry calculation).

Changing your workflow processes ensures safe billing practices.

This will prevent the accidental billing of code 77290 for patients who will be receiving IMRT. 

Often a simulation is done days prior to the treatment plan development.

For practices that bill on a daily basis, a charge for the simulation could be generated in error.

 

 

There are a few possible workarounds.  These can be made easier with built-in functionalities of Iridium Suite practice management software:

Hold all 77290 charges until the dosimetrist has completed the treatment planning process. As part of the flexibility of our claims batching, users can easily identify any 77290 service lines and avoid submitting them until the associated treatment planning code (77295, 77301, 77306, or 77307) is collected.

Review the physician prescription in the medical records. If the patient is receiving non-IMRT type treatment, code 77290 can be generated.  For an IMRT patient we allow the user to mark 77290 as “externally billed”.  This allows for tracking of services performed but will not charge the payer.

In case neither option works, you could use the built-in scrubber that will notify users that 77290 is a component of code when code77301 is entered.

Besides these helpful tools we are ICD-10 compliant.  Get a free demo today!!

Billing Hint:  The APCs have not changed for 77301/77290 so hospitals will still bill for code 77290, at lease for now.