Oncology & Hematology Coding Alert

Question: I am an experienced coder in other disciplines, but I just began working for an oncology office, and I'm having trouble adjusting to reporting radiation treatment management. When the oncologist provides radiation treatment management for a patient, what is included in a fraction of care?

Missouri Subscriber

Answer: Oncology offices that administer fractions of radiation treatment management use code 77427 (Radiation treatment management, five treatments) to report five fractions of treatment. The 77427 code represents the professional services of the oncologist while managing a course of radiation, and each fraction of care includes:

 reviewing and revising the treatment plan
 reviewing chart/dosimetry, including dosages used and treatment parameters
 reviewing port film or portal verification images
 treatment setup and positioning evaluation, immobilization device and block placement review
 treatment of infected skin (especially on ostomy site)
 writing medical prescriptions
 nutritional counseling/fluid electrolyte management
 telephone calls to/from the patient
 pain management. Remember that the oncologist should always provide at least five fractions of radiation treatment before reporting 77427. (Never report scheduled treatments that haven't been performed yet.) You should also refrain from reporting evaluation and management services with 77427 because the code includes E/M service.