Oncology & Hematology Coding Alert

Question: Should we code HDR and its components once or twice each day if we perform treatment on a patient twice in one day?

Wisconsin Subscriber

Answer: You should be able to report the code twice.

Support: "The HDR code (7778x) is employed for each HDR application (or fraction of treatment, whether multiple fractions daily, weekly or monthly) ... The remote afterloading CPT codes are used each time a treatment is given (i.e., each time the equipment is used to load radioactive material into the patient and provide a therapeutic dose of radiation)," according to an article from WPS Medicare (www.wpsmedicare.com/part_b/policy/rad036_billing.pdf).

Although this article still refers to the 2008 codes 77781-77784 instead of 2009 codes 77785-77787 (Remote afterloading high dose rate radionuclide brachytherapy ...), the minor change in descriptor wording shouldn't affect your ability to report the code more than once per day.

A September 2005 CPT Assistant article offers the same guidance: "The dose rate codes should be reported per treatment (i.e., each time the equipment is used to load radioactive material into the patient and provide a therapeutic dose of radiation)."

CPT Assistant advises appending modifier 59 (Distinct procedural service) to the second delivery code to indicate the separate nature of the service. In practice, payers may prefer that you use modifier 59 to indicate separate dose rates -- such as 77785 (... 1 channel) in the morning and 77786 (... 2-12 channels) in the afternoon -- and use modifier 76 (Repeat procedure by same physician) or 77 (Repeat procedure by another physician) for a repeat of the same dose rate.

The article also notes that payer guidelines may differ from those of CPT, so you should confirm your payer's preference for reporting the service twice per day, such as which modifier to use.