Ana Posted Fri 22nd of April, 2011 19:45:39 PM
May we bill a daily technical code twice if there are two plans? Treating two different sites, may we use modifier 76 for the 2nd code?
University of Miami
Renee Answered Fri 22nd of April, 2011 21:24:02 PM
This is from the CPT assistant. Hope it helps
A. Section XX. Billing for Radiation Therapy (CPT Codes 77401 through 77416).
The instructions in Section XX of Transmittal A-02-129 were incorrect. Those instructions are revised to read as follows:
CPT Codes 77401 through 77416 may be reported more than once per date of service only when radiation treatment is provided during completely different sessions. Only one of these codes may be reported for each treatment session no matter how many areas are treated or no matter how much radiation is delivered. CPT Codes 77402 through 77406 describe treatment delivery for a single treatment area. CPT Codes 77407 through 77411 describe treatment delivery to two treatment areas. CPT Codes 77412 through 77416 describe treatment delivery to three or more treatment areas. In the cases of CPT codes 77407 through 77416, the number of distinct treatment areas and complexity of the treatment determine which code series to report, which is then modified by the selection of energy (ie, MV). For example, if three treatment areas are each treated with 11 MV, then the proper code to bill is 77414. It is incorrect to report 77404 - 77414 (for "11-19 MeV") three times. However, if there is a distinct break and the same region or regions are treated again the same day then a second charge describing the energy and level of complexity is appropriate.
B. Section VI. Payment Policy When a Surgical Procedure on the Inpatient List is Performed on an Emergency Basis or When a Patient Whose Status is "Outpatient" Dies:
* Paragraph 4 in the instructions in Section VI.A. of Transmittal A-02-129 is replaced by the following new instruction:
Effective for services furnished on or after 01/01/03, the OCE assigns status indicator 'N' and packaging flag '1' to lines billed with the same date of service as a procedure on a claim with modifier -CA appended to a HCPCS code that has a status indicator 'C'.
* Instruct hospitals to report Patient Status Code 20 in FL 22 on a claim for a service billed with modifier -CA.
C. Section IV. A. Partial Hospitalization Program (PHP): Coding Partial Hospitalization Services.
Instruct providers that HCPCS codes 90875 and 90876 are not covered by Medicare and should not be billed for partial hospitalization program (PHP) patients.
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