News: Study shows nearly 10% improper payment rate for radiation oncology services

Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly pay $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter, JustCoding reported.

Radiation therapy may be administered in outpatient clinics and services may be billed based on the Healthcare Common Procedure Coding System (HCPCS) codes. Those working with radiation therapists should review codes highlighted by the study, including:

• 77300, basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off-axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
• 77301, intensity modulated radiotherapy (IMRT) plan, including dose-volume histograms for target and critical structure partial tolerance specifications

Code 77301 requires a treatment plan developed by the physician, medical physicist, and dosimetrist and is required for the delivery of IMRT, according to CMS. One of the leading causes of improper payment for these services was lack of documentation, including the radiation therapy plan. Other items missing from the medical record included:

• The physician’s signature
• The signature log or attestation for an illegible signature
• The correct date of service
• The documentation submitted did not adequately describe the service defined by the HCPCS code

Editor’s note: This article originally appeared in JustCoding, here. For more information, see the Medicare Claims Processing Manual or read the Medicare Quarterly Compliance Newsletter for an example and more CMS resources.