July 2008 Coding Tip (View More 2008 Coding Tips)

What is the appropriate planning code to utilize for the delivery of stereotactic treatment?

In 2006 CMS determined that hospital outpatient providers were not utilizing the G codes for stereotactic planning appropriately and decided to discontinue the use of these codes. When CMS discontinued the use of the two G codes that were utilized in the hospital outpatient setting (G0242 Multisource Photon Stereotactic Planning and G0338 Linear Accelerator Planning) hospitals were instructed to utilize the available appropriate CPT® codes normally associated with SRS planning. Appropriate codes may include CPT® code 77295 (Therapeutic radiology simulation aided field setting; 3-Dimensional); code 77300 (Basic radiation dosimetry calculation); and code 77370 (Special medical radiation physics consultation). Freestanding facilities and physicians had been utilizing the 77295 (3D planning) since the G codes were not recognized under the Medicare Physician Fee Schedule so no changes occurred with these providers with the deletion of the G codes. Revenue Cycle Inc. suggests the continuance of the 77295 for stereotactic planning due to the CMS document including this planning code. It should be noted that the 2008 Supplement to the ASTRO/ACR Guide to Radiation Oncology Coding 2007 suggests either the 77301 IMRT Plan or 77295 3D Planning. In the hospital outpatient setting, both the 77301 and the 77295 fall into APC 0310 with a national average payment of $863.82.