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2015 CPT Coding Update for Radiation Therapy

by | Dec 2, 2014 | Articles, Resources | 0 comments

2015 CPT Coding UpdateThis August, the American Medical Association (AMA) released the 2015 CPT coding update going to be effective from January 1, 2015 with relevant changes to radiation oncology. According to the American Society for Radiation Oncology (ASTRO), the coding changes will better reflect current practices in radiation oncology, especially Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT). The major changes introduced for these treatments are creation of codes for different levels of IMRT complexity, creation of technology independent IGRT code, which include the previous Category III tracking code and bundling of IGRT into IMRT delivery codes.

Reporting IMRT Delivery

From January 1, 2015, CPT code 77418 can no longer be used for reporting IMRT treatment delivery since it has been deleted as a part of coding update. Two new codes have been released for reporting this service such as:

  • 77385: Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple
  • 77386: Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex

Following are the criteria for reporting these codes.

  • Simple – Any of the following: prostate, breast, and all sites using physical compensator-based IMRT.
  • Complex – Includes all other sites if not using physical compensator-based IMRT.

Compensator IMRT (0073T) has been deleted and the code 77385 will be used for reporting this.

Since the technical component (TC) of image guidance and tracking is included in the new IMRT treatment delivery codes, the physician will have to report only the professional component (PC) of the new guidance and tracking code. The new complex conventional treatment delivery code (77412) now includes field-in-field techniques commonly used in treating breast cancer and it should not be confused with breast IMRT.

Reporting IGRT Delivery

CPT codes 77421, 76950 and 0197T have been deleted and the CPT code 77014 will no longer be used to describe the work associated with IGRT from January 1, 2015. A new code has been introduced to report all guidance and tracking.

  • 77387: Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

The TC of 77387 has been bundled into new IMRT delivery codes. It will be required to use 77387 with modifier 26 for reporting the professional component of guidance and tracking with IMRT. IGRT was not bundled into the conventional radiation therapy treatment delivery codes. If image guidance is performed during conventional radiation treatment delivery, report the global (TC and PC) of 77387. Do not report the TC of 77387 with 77371, 77372 or 77373.

Reporting Services Performed Together

IMRT and IGRT Performed

  • Freestanding Setting – Here, the physician bills IMRT code 77385 or 77386 and IGRT code 77387 with the -26 modifier (PC).
  • Hospital Setting – The hospital bills IMRT code 77385 or 77386 and physician bills IGRT code 77387 with the -26 modifier (PC).

Conventional Treatment Delivery with IGRT

  • Freestanding Setting – Physician bills treatment delivery code 77402, 77407 or 77412 and IGRT code 77387 – global (PC and TC).
  • Hospital Setting – Hospital bills treatment delivery code 77402, 77407 or 77412 and physician bills IGRT code 77387 with the -26 modifier (PC).

ASTRO expects the release of Medicare values for these new codes along with the 2015 Medicare Physician Fee Schedule Final Rule around November 1. Radiology oncology practices should revise their policies to improve their documentation to adopt these coding changes as early as possible in order to avoid a sudden drop in their revenue just after the coding update. They can benefit from the support of professional, experienced coding and billing experts to adapt to the new codes, reduce claim denials and receive maximum reimbursement.