Health Information Management

Q&A: Why are stereotactic radiosurgery claims being denied?

APCs Insider, January 31, 2014

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A: SRS has been reported with CPT® code 77371 (radiation treatment delivery, SRS, complete course of treatment of cranial lesion[s] consisting of one session; multi-source cobalt-60-based) and specific G-codes to distinguish between robotic and non-robotic procedures. 
However, with advances in technology, most procedures now include some type of robotic feature. CMS deleted the G-codes January 1, 2014, and began accepting CPT codes 77372 (SRS; linear-accelerator based) and 77373 (stereotactic body radiation therapy, treatment delivery, per fraction to one or more lesions, including image guidance, entire course not to exceed five fractions). 
CMS also issued specific reporting instructions in the OPPS final rule regarding these codes and will be instituting claims processing edits regarding the reporting and units. 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.


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