April 30, 2016

Coding Revisions Affect LCS and Radiation Therapy Billing

Medical imaging billing personnel should make note of actions by the Centers for Medicare & Medicaid Services (CMS) and National Correct Coding Initiative (NCCI) that affect how they should bill Medicare for lung cancer screenings of current smokers, 3D radiation therapy planning, and basic dosimetry calculations.

As covered in the March 2 ACR News (Coding Policies Clarified for LCS of Current Smokers), CMS has modified its coding policies for low-dose CT lung cancer screenings of current smokers with an implementation date of July 5, 2016.

Another article in the March 2 issue (CMS to Delete Inappropriate Radiotherapy Planning Edits) reports that NCCI will correct the procedure-to-procedure edit for column one CPT code 77295 (3-dimensional radiotherapy plan, including dose-volume histograms) in conjunction with the column two CPT code 77300 (basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off-axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician). The correction will appear in the NCCI’s July 1, 2016 quarterly update and will be retroactive to Jan. 1, 2016. 

The change to the coding policy for lung cancer screening of current smokers was made in response to comments by the American College of Radiology (ACR) and other specialty medical societies. The code corrections to radiotherapy planning procedures and the calculation of basic dosimetry followed requests by ACR, American Society of Radiation Oncology and American Association of Physicists in Medicine.

Readers are encouraged to monitor the ACR Radiology Coding SourceTM for billing and coding announcements and news.