Add Your Fractions Correctly to Avoid Fractured Claims
Published on Sat Jan 22, 2005
Be sure oncologist delivers three or more fractions before using 77427 If you don't know all of the special rules on reporting radiation treatment management (CPT code 77427), your office could end up missing out on payment for leftover fractions - or worse, coding for leftover fractions that should not be reported.
To code for radiation fractions properly, you should first be aware of what constitutes a "week" of radiation treatments. But those in the know recommend that you also get smart on reporting radiation treatment management for patients who only receive one or two fractions of treatment.
If you thought you saw the last of fractions in middle school, think again. Read on for some expert tips on coding radiation treatment fractions. 77427 Only for 3-5 Fractions The code descriptor for 77427 (Radiation treatment management, five treatments) indicates "five treatments" and is intended to represent five fractions in most cases. In an oncologist's office, you could very well hear five fractions of radiation treatment referred to as a "week" of treatments.
However, you can report fewer than five fractions with 77427 when reporting leftover fractions - as long as you use the code to represent three or more fractions.
How? Consider this example from Terry Blekeski, senior medical coder at CINJ in New Brunswick, N.J.: The oncologist delivers eight fractions of treatment to a patient with upper-lip cancer. On the claim, you should:
report 77427 x 2 for the eight fractions
attach ICD-9 code 140.0 (Malignant neoplasm of upper lip, vermilion border) to 77427 to prove medical necessity for the treatment. Remember progress notes: You should also include a physician progress note for each "week" of therapy. In this example, append one progress note for the first "week" (five fractions) of treatment, and another for the final three fractions.
Don't take "week" literally: You do not necessarily administer a "week" of fractions on five consecutive days. With some patients, the oncologist may skip a day or two between treatments; other patients may require multiple fractions of radiation treatment management on a single date of service. Report 77427 Once for Fewer Than 3 Fractions However, if the same patient with upper-lip cancer received six fractions of treatment, you would report 77427 only once, says Laurel L. Huebscher, CPC, with the University of Minnesota Physicians Radiation Oncology, Radiology, and Lab Medicine and Pathology.
Report code 77427 "if there are three or four fractions beyond a multiple of five at the end of a course of treatment," she says.
Truth: "But if there are one or two fractions beyond a multiple of five at the end of a course of treatment, you should not report the fractions separately," Huebscher says.
Consequences: If you report 77427 x 2 [...]
