2015 Radiation Oncology – Which do you Want First, the Good News or the Bad?

I prefer starting with the bad news. 

CMS was unable to make up their mind on new treatment delivery codes that were supposed to take effect in 2015.

As their interim solution, they have decided that hospital radiation services will utilize some “redefined” existing CPTS.

2014 CPT                                           2015 CPT

77402 77403                                                    77402 77404 77406

77407 77408                                                    77407 77409 77411

                         77412                          77413                                                    77412                          77414                          77416

If they were using the same process for freestanding centers, there would be much less confusion, but instead they are requiring the use of temporary G codes.

When you throw commercial payers into the mix, the confusion is compounded.  Some of those may want to see the CPTs instead of the G codes. The bad news, it got worse.

                                                              2014 CPT                                         2015 G-Codes

                                                                77402                                                    G6003                                                                 77403                                                    G6004                                                                                                                   77404                                                    G6005                                                                 77406                                                    G6006                                                                 77407                                                    G6007                                                                 77408                                                    G6008                                                                 77409                                                    G6009                                                                 77411                                                    G6010                                                                 77412                                                    G6011                                                                 77413                                                    G6012                                                                 77414                                                    G6013                                                                 77416                                                    G6014                                                                 77418                                                    G6015

Now it’s time for the good news.  The crack team of software developers at Medical Business Systems has created several tools that Iridium Suite medical billing software users are very excited about.

     For hospital based clients, the system will recognize the 2015 CPTs and provide replacement options to the professional G-Codes.

If any inactive 2014 CPTs are entered in error, the user is warned.  This allows the opportunity to correct the claim before it is sent to the payer and denied.

To accommodate the potential that commercial payers will require CPTs instead of G-Codes, an innovative “crosswalk” tool was created to generate charges to specific payers meeting their individual requirements.

At Medical Business Systems, our philosophy is to always “work smarter, not harder”.  Give us the opportunity to show you how we can help you!