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Karen Posted Wed 16th of May, 2012 16:57:30 PM

OUr consultant said that a confirmation image needs tobe taken to prove that the shifts were performed,asolder LCD's mentioned this:
"Older policies included the requirement, 'Adjustments are confirmed using REPEAT IMAGING or infrared tracking.' ... IS this still a requirement - what if there was no shifts required?

SuperCoder Answered Wed 16th of May, 2012 18:22:22 PM

CMS has recently changed the supervision requirements for CPT code 77421 to direct supervision. This means the physician must be present and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. The physician work to bill the professional component need not be a real time review and approval of the images but should be documented and signed the same day. They may be performed as medically appropriate and billed whenever the service is provided.

It is appropriate to bill one unit of CPT® code 77421 when IGRT(Image Guided Radiation Therapy) is used to treat two separate anatomical areas. CPT code 77421 requires direct physician supervision to bill for the professional and technical component of the work performed.

The medical record should contain documentation of the medical necessity for the procedure, describing the medical appropriateness, the target delineation methodology, the type and frequency of imaging, acceptable parameters for shifts and information on the fusion algorithm. The images and shifts are to be reviewed and approved by the radiation oncologist prior to the patient’s next treatment. Appropriate documentation could be a note to the patient’s chart and/or a physician’s electronic signature on the shifts/images. A unique daily note is not required.

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