Davon Posted Tue 05th of March, 2013 14:53:07 PM
We have purchased an SRT machine to treat superficial BCC and SCC of the skin and have been advised by our salesman to use codes '77401' for a single lesion (which is appropriate). However, when treating more than one lesion, we have been told to use '77407' for two lesions and '77412' for three lesions even though we are not using 3 or more ports as the coding states. Also, our local LCD with Medicare states that is would not be expected to use these codes. Please provide any additional information you may have.
SuperCoder Answered Wed 06th of March, 2013 02:50:15 AM
** Perhaps your LCD is from First Coast Service Options? Local Coverage Determination (LCD): Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinomas of the Skin (L31510) includes the following:
* “It is not expected that the treatment delivery codes 77407, 77408, 77409, 77411, 77412, 77413, 77414, and 77416 will be utilized for treatment of BCC or SCC stage T1 lesions. Claims for such services may be developed (records requested when claims submitted) for prepayment medical review.”
* “Hyperfractionation (BID treatment delivery) is non-covered for treatment of BCC or SCC stage T1 lesions.”
* “Grenz rays (< 30 KV) is non-covered for any skin cancer condition.”
* “Radiation treatment delivery, superficial and/or ortho voltage is defined as 50 KV or greater. Energies less than 50 KV are non-covered.”
* “Intensity modulated radiation therapy (IMRT) (77418) for the treatment of BCC or SCC stage T1 is non-covered.”
* “Stereotactic radiation treatment delivery and proton beam treatment delivery for the treatment of BCC or SCC stage T1 is non-covered.”
So from the above, 77401 (Radiation treatment delivery, superficial and/or ortho voltage) appears to be the correct option for superficial radiation therapy, which is often described as low energy radiation beam (x-ray) within the range of 50-150 kV (kilovoltage). Additionally, the huge jump between the Medicare fees for 77401 and 77407 suggests they are not intended to describe similar services.
** Here’s a quote from consultants (not authoritative but a source of advice):
“Performing daily treatments using an orthovoltage or superficial treatment machine is reported using the CPT Code® 77401 (radiation treatment delivery, superficial and/or orthovoltage). The same principles apply when treating with photons or electrons using a linear accelerator. Only one daily treatment charge is billable, regardless of the number of areas treated in each fraction of treatment. Only when medically necessary and supported by documentation of six hours elapsing between daily treatments, a BID treatment is billed and the appropriate modifier is attached to the second daily fraction. It would be inappropriate to bill a daily treatment charge for each individual lesion if they were treated as part of one treatment session.”
** Medicare refers to 77401 in the manual quote below:
70.3, Radiation Treatment Delivery (CPT 77401-77417)
Carriers pay for these TC services on a daily basis under CPT codes 77401-77416 for radiation treatment delivery. They do not use local codes and RVUs in paying for the TC of radiation oncology services. Multiple treatment sessions on the same day are payable as long as there has been a distinct break in therapy services, and the individual sessions are of the character usually furnished on different days. Carriers pay for CPT code 77417 (Therapeutic radiology port film(s)) on a weekly (five fractions) basis.