Oncology & Hematology Coding Alert

Question: One of our established patients recently began radiation treatments for skin cancer. The patient received seven fractions of radiation, and we're stumped at how to code for this number. Can we get payment for all seven fractions?

Louisiana Subscriber

Answer: Unfortunately, you'll only be able to report the first five fractions of treatment. On your claim, you should file 77427 (Radiation treatment management, five treatments).

That means the office will have to absorb the cost of the extra two fractions, but the insurer will not pay for one or two fractions of radiation. When the oncologist provides radiation therapy for a patient, you cannot use code 77427 unless you are reporting three or four extra fractions of treatment.

For example, if the same skin cancer patient had received nine fractions of radiation, you could have reported 77427 x 2 (one unit of 77427 for each week of therapy in which at least three fractions were delivered).

Warning: Never report leftover radiation therapy fractions with 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only). This code is designed for reporting entire radiation therapy courses that use only one or two fractions of radiation.