Lori Posted Mon 01st of August, 2016 15:36:42 PM
What is the correct way to code Medicare claims for the IMRT & IGRT for 2016?
SuperCoder Answered Tue 02nd of August, 2016 05:44:38 AM
Providers billing under Medicare were instructed to report IGRT services using the following Healthcare Common Procedure Coding System (HCPCS) G-codes and CPT code:
G6001: Ultrasonic guidance for placement of radiation therapy fields
G6002: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
77014: Computed tomography guidance for placement of radiation therapy fields
These codes can also be used to report the professional component (PC) of IGRT services for providers in a hospital setting by attaching the -26 modifier to the codes. Note: G6017 is a technical-only code, therefore the -26 modifier cannot be attached.
The new IMRT treatment delivery codes (77385 and 77386) include guidance and tracking, when performed. The technical component (TC) of IGRT (77387-TC) is packaged into the IMRT service with which it is performed, and is not reported separately in either the freestanding or hospital setting. However, the professional component (PC) of IGRT can still be reported. To report the PC, a physician would typically bill 77387 with the -26 modifier attached. However, CPT code 77387 did not receive a value in the Medicare Physician Fee Schedule (MPFS) in 2016.
In the freestanding office setting, the physician reports the correct IMRT code. Depending on the insurance carrier, this will be G6015/G6016 or 77385/77386. If the carrier requires 77385 or 77386, the physician reports only the PC of IGRT by attaching the -26 modifier to one of the following codes: G6001, G6002, 77014, or 77387 depending on the modality used to perform the IGRT services. If the carrier requires G6015 or G6016, then the physician reports the appropriate IGRT code as a global charge. Note: As 77385 and 77386 do not have assigned relative value units (RVUs) in the MPFS, providers are advised to confirm with payers accepting these codes that carrier pricing includes the IGRT technical payment.
In the hospital setting, the hospital reports the correct IMRT code, and the physician reports the PC of IGRT. The physician may attach the -26 modifier to one of the following codes: G6001, G6002, 77014,or 77387 depending on the modality used to perform the IGRT services.
Many private payers will accept G-codes in 2016; however, certain private payers may only accept 77387-26. It is extremely important to check with your payer to see whether they will be accepting the new CPT codes or HCPCS G-codes before submitting claims.
Lori Posted Tue 02nd of August, 2016 17:28:53 PM
If IMRT(77385/77386)are performed in an office setting and the technical portion is billed by the hospital facility, would G6002 or G6015 be the correct code to use for the physician services? Also when the office charges for a 77412, is there a professional code that should be billed for this technical code? Thank you
SuperCoder Answered Wed 03rd of August, 2016 03:22:20 AM
For Medicare purposes,77385/77386 procedure is not assigned RVUs and providers are instructed to use HCPCS Level II code G6015 or G6016 to report this service. Also, Code 77412 does not have a technical and professional component; it should only be billed as a complete service. Medicare and some other payers may require HCPCS Level II code G6011, G6012, G6013, or G6014 be reported for this service.
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