Coding for Fractions:
Radiation Treatment Versus Radiation Therapy
Published on Tue Jan 01, 2002
When billing for treatment management in radiation oncology, practices should report 77427 (radiation treatment management, five treatments) for five fractions at a time, which describes five treatment sessions. Often, however, the number of fractions completed does not equal five or a multiple of five. To bill for three or four leftover fractions, again use 77427.
For example, if nine fractions were completed prior to the end of a patient's radiation treatment, 77427 would be reported twice, once for the first five fractions and a second time for the remaining four.
According to Jim Hugh, director of Atlanta-based AMAC, a coding and billing consulting firm, radiation oncology practices commonly make three mistakes:
Billing for one or two remaining fractions using 77427;
Using 77431 (radiation therapy management with complete course of therapy consisting of one or two fractions only) for each of the remaining fractions;
Allowing payers to steer them away from the proper use of 77427.
How to Use 77427
Radiation treatment management represents the professional services of the physician managing a course of radiation therapy. Clinical treatment management is the ongoing management of a course of radiation therapy using any energy of photon-beam or high-energy particle source.
Radiation treatment management is reported in units of five fractions or treatment sessions regardless of the time in which the services are furnished. The services do not need to be provided on consecutive days, says Margaret Hickey, MS, MSN, RN, OCN, CORLN, and independent coding consultant based in New Orleans. Code 77427 includes the ongoing supervision and care of the patient during the entire course of radiation therapy by the radiation oncologist. Each fraction consists of physician services that typically include:
Review of and revision of treatment plan;
Port film or portal verification image review;
Chart and dosimetry review, including dose delivered to date and treatment parameters;
Treatment setup and positioning evaluation, review immobilization devices, block placement;
Care of infected skin, special care of ostomy site;
Medical prescription writing;
Nutritional counseling, fluid electrolyte management;
Telephone calls to or from the patient; and
Pain management.
These services are provided to the patient as part of radiation treatment management and should not be billed separately from 77427.
According to CPT guidelines, multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy sessions, and the fractions are of the type that would usually be furnished on different days.
Under these guidelines, radiation oncology practices should wait until at least five fractions have been completed before reporting 77427. Practices should not bill for those that are scheduled but not yet performed.
Hyperfractionated Radiation Therapy
On the other hand, hyperfractionated radiation [...]
