Clinical Practice Guidelines Guidelines are "Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options" as defined by the National Academy of Medicine (formerly Institute of Medicine). Billing and Coding Guidelines (continued…) Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. 2021 Radiation Oncology Coding Resource Updated for changes effective January 1, 2021, the Coding Resource is an essential coding reference for all radiation oncology practices. Download the Full PDF Radiation Oncology Medical Billing Services. To learn more, click here. It describes the physician work and resources involved in acquiring a respiratory correlated or 4-D Ct simulation study for conformal planning. Radiation Oncology: Billing and Coding Guidelines (Part II) August 9, 2020. admin. Each time a procedure is reported, its level of effort and complexity should be appropriately documented. A 2/3 mitigation of the cut to the Physician Fee Schedule conversion factor in 2021 as a result of the 3.75% increase in the Physician Fee Schedule and a three-year delay in the new G2211 add-on code (more information is provided below). ASTRO’s SBRT guidance states that the CPT instructions for CPT code 77373 SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions include the possibility of treating multiple sites of disease in one treatment course. Treatment planning which involves simulation is used to actually direct the treatment beams to the specific volume of interest. OPEN THE GUIDELINES FOR RADIATION ONCOLOGY COMING SOON RADIATION ONCOLOGY GUIDELINES EFFECTIVE MARCH 14, 2021 Simple planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking. Portal changes based on unsatisfactory initial simulation(s) are not reported as additional simulations. This is the first post in our Radiation Therapy Billing FAQ Series.Billing is an essential function in radiation therapy departments but can be challenging for any clinician. Though 77014 is grouped with the simulation codes, it still represents image guidance services. Complex planning includes interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures. Treatment of multiple sites CPT® code 77470 is reported once per episode of care B. The radiation oncologist with his team is … However, you must report a single simulation on any given day. Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) Contractor's Determination Number . When billing this code, practices should be certain of the individual payer’s requirements for unlisted procedures. We have recently updated our privacy policy and terms of use. On Friday, November 1, 2019 the Centers for Medicare and Medicaid Services (CMS) issued the 2020 Hospital Outpatient Prospective Payment System final rule lowering the supervision level required for hospital-based therapeutic services, including radiation therapy services, from direct to general supervision. We hope this guidance helps radiation oncology practices as they navigate potential billing issues. On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized the Radiation Oncology (RO) model, a mandatory payment model that requires participation from radiotherapy (RT) providers and suppliers that furnish RT services within randomly selected core-based statistical areas (CBSAs)—which are linked to ZIP Codes. RAD-014 . In addition to coding FAQs, coding guidance articles and coding updates, which provide information on a variety of coding topics, ASTRO also circulates reimbursement reminders, called Radiation Oncology Reimbursement Reminders (RORR), to help practices address common coding and coverage issues. Radiation Oncologist (one of these) Board Certified in Radiology or Radiation Oncology: ABR certification in radiology (for a physician who confines his/her professional practice to radiation oncology) or certification in radiation oncology or therapeutic radiology by the ABR, AOBR, RCPSC or CMQ is considered proof of adequate qualification. Each time a procedure is reported, its level of effort and complexity should be appropriately documented. The treatments addressed in the AIM Clinical Appropriateness Guidelines for Radiation Oncology include brachytherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery. Keep a note that all documentation should be specific to the patient being treated or the claim will be denied. The number of films taken per treatment, the modality from which the images for simulation are obtained, and the use of fluoroscopy are not determinants of complexity. Indications are need to be listed as covered under the coverage indications, limitations, and/or medical necessity section otherwise claims will be denied as not medically necessary. ASTRO’s 2020 Radiation Oncology Coding Resource states: “Supporting documentation, including ICD-10-CM codes, is needed to justify the distinctions between codes that represent apparently similar activity but different levels of effort and complexity. It is not mandatory to provide the complete medical record. Generally, this includes the primary tumor organ or the resection bed and the draining lymph node chains. Treatment with Proton Beam Therapy (PBT) 8. CPT code 77261 is used when the volume of interest to be treated is clearly defined and easily encompasses the tumor while excluding normal tissue and structures. 77370 (Special medical radiation physics consultation) CPT® code 77370 is very similar to 77470 in that it documents additional work that is not routinely required for a radiation therapy episode of care. IMRT is also known as conformal radiation. The difficulty of the simulation is based on number of ports, volumes of interest, and the inclusion and type of treatment devices. When reason for additional services not justifiable by documentation and excessive frequency when services rendered more frequently than generally accepted by peers. Not all parameters of treatment are completed each week because the clinical course of care may differ due to variation in treatment modality and individual patient requirements. Compliance with coding and billing guidelines. Here is the Radiation oncology Billing and Coding Guideline. It includes information on updated CPT and HCPCS codes that went into effect January 1, 2021. The Radiation Oncology (RO) Model team will host a RO Model 101 webinar to provide an in-depth look at the recently finalized RO Model. The Radiation Oncology (RO) Model is an innovative payment model that aims to improve the quality of care for cancer patients receiving radiotherapy treatment, and move toward simplified and predictable payments. After carefully reviewing the rule and clarifying questions with the Agency, the ASTRO … Whether it’s institutional scale or the continuing adoption of newer technologies, our specialty must interpret and adapt to the existing rules and guidelines that do not encompass our current work environment. It requires three (3) or more converging ports, two (2) separate treatment areas, multiple blocks, or special time dose constraints. Many of the procedures within each phase of care will be carried to completion before the patient’s care is taken to the next phase.” For more information, see page 28 of the 2020 ASTRO Radiation Oncology Coding Resource. Otherwise, an attachment shall be submitted with the claim.” (Chapter 26, page 16.). Physicians hold responsibility for all the technical aspects of the treatment planning process. ASTRO’s 77014 Coding Guidance explains: “Since the development of the simulation codes, there have been significant changes in the process of care for physician and other qualified health care professionals, as well as the nature of the equipment utilized. Coding Guidelines . Radiation oncology services include initial consultation, clinical treatment planning, simulation, medical radiation physics, dosimetry, measurement devices, … Radiation Oncology : Billing and Coding Guidelines (Part I) August 6, 2020. admin. These guidelines summarize definitions and appropriate use of several CPT ® codes. Do not let Covid-19 impact your practice. LCD Title . The NCCN Guidelines™ and illustrations herein may Payers report that some practices bill for all services delivered in a course of treatment on every claim that are not necessarily performed during each individual treatment session. Radiation Oncology, Radiation Oncology medical billing services. Nov 14, 2020 coding and medicare for radiation oncology Posted By Barbara CartlandPublic Library TEXT ID 342dd42e Online PDF Ebook Epub Library CODING AND MEDICARE FOR RADIATION ONCOLOGY INTRODUCTION : #1 Coding And Medicare For Radiation Publish By Barbara Cartland, Coding And Billing Guidelines Radiation Oncology Including Please call 302-261-9187. Appeals for denied claims must be supported by that portion of the patient’s medical record that documents the reason for the service. Radiology: Oncology Page updated: December 2020 This section describes policies and guidelines for billing radiation oncology procedures. Some practices appear to confuse the services described by CPT codes 77280-77290 Therapeutic radiology simulation-aided field setting; simple-complex and CPT code 77014 Computed tomography guidance for placement of radiation therapy fields. 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