| Specialty
Groups — Oncology
I’m Sure It’s All a Terrible Mistake… … CPT code 76370 is defined
as “computerized tomography guidance for placement of radiation therapy
fields.” In general, CT slices are obtained of the area of interest, and
transferred to the treatment planning system for use when determining the
placement or optimal number and arrangement of ports for external beam
therapy (or in certain brachytherapy treatments). This service has also
been referred to as a “stealth” CT, since the images may not be
independently viewed prior to incorporation in the treatment plan. According to the CPT Assistant (Fall 1991)
and information contained in the RBMA Bulletin (February 2001, reprint of
ACR article), there is no professional component for this service, since a
separate interpretation and report is not generally performed. This
service is not considered to be a diagnostic test because the patient
already has a known malignancy with planned treatment, and there is
typically no medical necessity for an interpretation separate from the
treatment planning service. Facilities, either hospitals or
freestanding centers, have captured and billed for the technical component
of this service since the inception of three-dimensional planning. Prior
to October 1, 2001 most payors provided reimbursement for the acquisition
of the CT slices separately from the 3-dimensional simulation, with
appropriate documentation. The medical record may be documented by the
technologist or therapist performing the service, and generally includes a
log of the service date, anatomic area scanned and number of slices
obtained. However, the newest version of the Correct
Coding Initiative (7.3) includes an edit bundling the CT slices (76370)
into the code for 3-D simulation (77295). The indicator for this code
combination is “0”, which means that the application of modifier –59
will not bypass the bundling edit. In many hospitals the CT slices are
obtained in the radiology department because a dedicated CT scanner is not
located in the cancer center or oncology department of the facility. This
bundling edit will combine technical resources expended by different
departments into one reimbursement, making the tracking of costs and
allocation of reimbursement more difficult for some facilities. Radiation oncology providers must be
careful not to manipulate the dates of service to ensure reimbursement.
With increasing frequency, local carrier policies are including verbiage
that indicates a combination of services are bundled during a course of
treatment or for the same tumor volume. As with all controversial issues,
make certain that local payor guidelines are obtained and followed to both
ensure that appropriate reimbursement is received and compliance with
guidelines and policies is maintained. Reprinted with permission from the Journal of Oncology Management Jan/Feb issue. Cindy
C. Parman, CPC, CPC-H
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