Oncology Article

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-Hcparman-8320670
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.