Radiation Oncology has not had a lot of wins in the reimbursement arena as of late. That is until now. Effective January 1, 2016, the billing of basic dosimetry code 77300 when creating a 3D treatment plan, code 77295, was bundled using the NCCI Edits.
Providers have been unable to be reimbursed for those calculations. Noting the work involved and the medical necessity, arguments were placed with the powers that be. It was a success and the decision was overturned. That is victory #1. It gets better. They have made it retroactive, meaning all procedures performed since January 1, 2016 are billable and reimbursable separate services. That is victory #2.
This is not brand new information. It was published a few months ago and at that time, some providers started billing the code just to get the denials. This was a strategy to avoid the timely filing rejections and set the stage for the appeals process and subsequent payment.
If your practice took that approach, then you are ready to start the process of getting those paid ASAP.
For practices that did not, here are a few suggestions:
Run a report to find all patients who were billed code 77295
Report Center>Account Receivable>Service Line Search>Output Format: Tabular>Crosscut Class: Payer>Service Line Date Type: Date of Service>Date Range: Current Year>CPT Code Constraint: 77295
Helpful Hint: By using the Payer Crosscut, you can work on payers that have the shortest timely filing rules first. This will help you avoid as many of those types of denials as possible.
Once you have your list of patients, you will review the patient medical record to determine the proper # of units to bill for the basic dosimetry code 77300.
Helpful Hint: You can compare the # of units to the # units of treatment device codes77332- 77334 billed with the 3D plan 77295. It is not always a 1:1 ratio, but is most of the time.
You are now ready to submit your claims and recoup that lost revenue.
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