Oncology & Hematology Coding Alert

Answer: According to Chapter 13 - Radiology Services and Other Diagnostic Procedures of the Medicare Claims Processing Manual, “a weekly unit of treatment management is equal to five fractions or treatment sessions,” and a week is “comprised of five fractions regardless of the actual time period in which the services are furnished (www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/clm104c13.pdf).

That means 77427 (Radiation treatment management, 5 treatments) represents five fractions or one week of service as its descriptor states.

The manual instructs that, if there are one or two more fractions beyond that multiple of five, “payment for these services is considered as having been made through prior payments.” In other words, you should bill 77427 for 5-7 fractions, or one week. But if you go “three or four fractions beyond a multiple of five, those three or four fractions are paid for as a week.”

So, once you go beyond the threshold of seven fractions, you can bill two units of 77427 for 8-12 fractions; from 13-17, three units; from 18-22, four units, and so on. Treatments of 1-2 fractions only are not payable per Medicare.

Don’t forget to count same-day fractions: The manual also tells you that you can count more than one treatment when administered on the same day “as long as there has been a distinct break in therapy sessions, and the fractions are of the character usually furnished on different days.”