Medicare Compliance & Reimbursement

Double your reimbursement by noting when radiation therapy is twice daily. The Centers for Medicare & Medicaid Services (CMS) has said you can bill for twice-daily radiation therapy as long as the treatments happened in "different sessions." But you have to be careful to follow the rules and avoid getting into trouble by billing for different sessions that were really just parts of the same session.

Blue Cross Blue Shield of Florida defines "hyperfractionation" as any technique of radiation treatment that delivers more than treatment session per day, notes Cindy Parman with Coding Strategies in Atlanta.

Important: To be considered separate, two sessions should be at least six hours apart, says Deborah Churchill with Churchill Consulting in Killingworth, CT. This six-hour delay is important for the patient's cells to recover and associated radiation biological effect (RBE) from the second fraction, she says.

In some cases, the time between fractions may be as short as four hours, notes Parman.
 
Read your doctor's documentation carefully, Churchill adds. The doctor should call for treatments "BID," which means twice a day. Sometimes, the doctor may even order treatments "TID," which means three times a day, says Parman. The doctor will make this notation as part of the patient's treatment plan (CPT codes 77261-77263), Parman adds.

Also, the doctor will usually call for somewhat lower levels of "daily fractionation" if the patient is receiving radiation therapy more than once per dy, says Churchill. A standard daily treatment is around 180 centigray or greater, but a twice-daily treatment will be more like 100 to 140 centigray.

The coder should also report what the providers did, Parman adds. "The therapist, physicist, dosimetrist and other members of the radiation care team will have already reviewed the physician's order and planned the treatment accordingly," she explains.

Even though coders refer to management code 77427 as a "weekly" management code, you can bill it once per five fractions the patient receives. So if the patient receives 10 fractions in a given week, you could bill 77427 twice in one week. But you must make sure the doctor has seen and examined the patient during that period, warns Churchill. Your documentation must include an "on-treatment" visit note, she adds.