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Tierni Posted Tue 07th of July, 2015 18:44:01 PM

What are the correct HCPCS/CPT codes for the professional portion of IMRT treatment(77385/77386)?

SuperCoder Answered Wed 08th of July, 2015 00:13:06 AM

CPT code 77385 and 77386 are complete code which includes both professional component and technical component of the procedure. To bill the professional component append -26 modifier with CPT 77385 or 77386. Where 77385 stands for Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple and 77386 stands for Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex. Here simple refers to involving the targeting tumor cells of the prostate, breast, or other sites, with a high dose of radiation, using a physical compensator, thereby minimizing the effect of radiation on the normal surrounding tissues. Complex refers to all other sites of treatment and does not include the use of a physical compensator.

Tierni Posted Wed 08th of July, 2015 13:26:30 PM

Per ASTRO, it states to use 77387-26 for the professional charge. Medicare is denying this code (not on their fee schedule). Supercoder also states to use 77387-26. Looking for HCPCS code to use for Medicare billing.

SuperCoder Answered Thu 09th of July, 2015 00:38:49 AM

Please read the coding guidelines below:

All treatment delivery codes are reported once per treatment session. The treatment delivery codes recognize technical-only services and contain no physician work (the professional component). In contrast, the treatment management codes contain only the professional component.

Image guided radiation therapy (IGRT) may be used to direct the radiation beam and to reflect motion during treatment. A variety of techniques may be used to perform this guidance including imaging (eg, ultrasound, CT, MRI, stereoscopic imaging) and non-imaging (eg, electromagnetic or infrared) techniques. Guidance may be used with any radiation treatment delivery technique and is typically used with IMRT delivery. IMRT delivery codes include the technical component of guidance or tracking, if performed. Because only the technical portion of IGRT is bundled into IMRT, the physician involvement in guidance or tracking may be reported separately. When guidance is required with conventional radiation treatment delivery, both the professional and technical components are reported because neither component of guidance is bundled into conventional radiation treatment delivery services.

Bill CPT 77387 alone (without -26 modifier) for Professional component.

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