Health Information Management

Bill 77290, 77295 separately when provided on different dates of service

APCs Insider, September 29, 2006

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Bill 77290, 77295 separately when provided on different dates of service

QUESTION: National Correct Coding Initiative (NCCI) edits indicate that we cannot report 77290 (Therapeutic radiology simulation-aided field setting; complex) and 77295 (Therapeutic radiology simulation-aided field setting; three dimensional) on the same date of service. Can we report both codes for these services when provided within three days of each other?

ANSWER: By definition, NCCI edits apply to the same date of service. CPT code 77290 is considered a component of 77295, and you cannot use a modifier to bill these together when a radiologist provides both services on the same date. If a radiologist performs one of these services either one, two, three, or any number of days before or after the other service, you may bill for both.

Unlike the Medicare 72 hour or 3-day bundling rule (which applies to inpatients only), the OPPS does not associate services across days.



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