In Radiation Oncology, technology usually evolves faster than the billing codes that represent the services.  Below you will find coding changes slated to take effect January 1, 2014. 

77295 is a perfect example of coding lagging behind technology.  It was originally lumped in with the actual “hands-on” patient physical simulation codes, 77280-77290.  Those of us that have been billing in radiation oncology have just “overlooked” its misplacement for many years.  We are aware that this code represents the “behind the scenes” work performed by the physics and dosimetry staff in conjunction with the physicians in planning a 3D treatment course.

The AMA has decided that 77295 will be officially moved to the Medical Radiation, Physics, Dosimetry, Treatment Devices and Special Services subsection of the CPT book (CPT codes 77300–77370). The descriptor has been revised to reflect this change:

Previous descriptor: therapeutic radiology simulation-aided field setting; 3-dimensional

Updated descriptor: three-dimensional radiotherapy plan, including dose-volume histograms

 Note:  This change should have no effect on the circumstances of when this code should be billed.  

Other revisions have been done to all the other established simulation codes 77280-77290.  This is also is keeping with the ever changing technology of radiation therapy. 

Process changes made in the performance of simulations required redefining the levels of complexity in ways that reflect the real added work performed by radiation oncologists. Also the references to ports, blocks, etc. have been removed.  Now the level of coding is based on the number of “Treatment Areas”. 

A treatment area is a contiguous anatomic location, such as primary tumor organ or the resection bed and applicable lymph nodes that will be treated with radiation therapy.  

The descriptors have been revised to reflect this change:

Previous descriptors:    

77280 Therapeutic radiology simulation-aided field setting; simple. Simulation of a single treatment area with either a single port or parallel opposed ports.  Simple or not blocking.

77285 Therapeutic radiology simulation-aided field setting; intermediate. Simulation of 3 or more converging ports, two separate treatment areas, multiple blocks.

77290 Therapeutic radiology simulation-aided field setting; complex.  Simulation of tangential portals, 3 or more treatment areas, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, hyperthermia probe verification, any use of contrast materials.

Updated descriptors:    

77280 Therapeutic radiology simulation-aided field setting; simple. Simulation of a single treatment area.

77285 Therapeutic radiology simulation-aided field setting; intermediate. Simulation of two separate treatment areas.

77290 Therapeutic radiology simulation-aided field setting; complex.  Simulation of 4 separate fields. Simulation of 3 or more treatment areas or any number of treatment areas if any of the following are involved: particle, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, hyperthermia probe verification, any use of contrast materials.

  Note:  This change also bundles the CT Simulation, so the technical charge of acquiring the CT (CPT code 77014 TC) will no longer be reported separately for simulation.

CPT code +77293, a new add-on code was created. This new code describes the physician work and resources involved in acquiring a respiratory correlated or ‘4-D’ CT simulation study for conformal planning. The plus (+) symbol in front of the code number indicates that this is an add-on code. Add-on codes are never performed independently and must be reported in addition to the primary procedure.

Note: This code must always be billed in conjunction with either CPT code 77295 or 77301 and on the same date of service (even if the actual work was performed over several other days).

 Medicare billing news for Clinical Trials:  January 2014 is the implementation date for the mandatory reporting of clinical trial services.  To ensure processing, your outpatient professional claims must include the following:

 The 8 digit clinical trial number must be included in Box 19 (or the corresponding 837P electronic equivalent ) in this format: CT12345678.

 Either ICD-9 diagnosis V70.7 or ICD-10 diagnosis Z00.6 must be submitted as either the primary or secondary diagnosis.

The appropriate modifier of Q0 or Q1 must be appended to the service charge.

Any claims received without the required items will be returned as unprocessable.

Further details on changes to clinical trials billing can be found on the CMS website by searching for MLN Article #MM8401.