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IMRT coding in physician's office

Karen Posted Tue 20th of August, 2019 16:19:06 PM
Our practice has hired 2 Rad Onc physicians who have come from a hospital setting; they are used to 77385 and 77386. One of them is insisting that there is a code that physicians in a free-standing treatment center (office) can bill that reimburses as much as 77386. We use RapidArc technology (MLC) and we do not use compensators, so I believe the only code we can bill is G6015. Is the correct? I've tried to explain that 77385 and 77386 are under HOPPS, but he does not believe me.
SuperCoder Answered Wed 21st of August, 2019 07:45:44 AM

In CPT 77385, the provider begins the treatment by identifying the tumor using image guidance, typically computed tomography or magnetic resonance imaging. He marks the patient’s skin with a special ink to specify the target location. He then uses a computer to calculate the optimal dose of the radiation to target the tumor site. He uses a physical compensator to modify the radiation beam so as to control the amount of cumulative radiation dose within the target and the acceptable radiation dose limits for the surrounding normal tissues.

Whereas, in CPT 77386, the provider begins the treatment by identifying the tumor using imaging guidance, primarily computed tomography, or CT; or magnetic resonance imaging, or MRI. He then uses a medical linear accelerator and multileaf collimator, or MLC, to deliver the optimal dose of the radiation to the targeted area and control the radiation beam so that the amount of cumulative radiation remains within acceptable dose limits for the surrounding normal tissues.

For intensity modulated radiation treatment delivery with the use of compensator, use code 77385, Intensity modulated radiation treatment delivery, or IMRT, includes guidance and tracking, when performed; simple. In Code 77386, provider uses a medical linear accelerator and multileaf collimator, or MLC.

On the other hand, HCPCS code G6015 is correctly used to the Medicare patients for Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session. This code can be reported when the patient receives high intensity radiation using a dynamic multileaf collimator, or MLC, controls the radiation intensity and timing of each beam. The MLC delivers radiation beams of different widths over single or multiple fields or arcs to treat the tumor. Before initiating the therapy, the provider analyzes the type, size, shape, and location of the tumor, to calculate the number of radiation sessions and dose, and identify accurate location for the treatment. The MLC device targets the tumor with high intensity radiation, whereas the surrounding local healthy tissues receive low intensity modulated beams. Report this code for each treatment session that the patient receives.

As per Medicare guidelines, codes G6015 and G6016 are used for payment under the MPFS (Office Visits) and CPT codes 77385 and 77386 will be used in OPPS (Hospital Settings). Means, CPT 77385 and 77386 can be billed under Hospital Outpatient and Inpatient settings.

Hope this helps!

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