Attention to Treatment Code Nuances Will Increase Payment
Published on Mon Jan 01, 2001
Coders lives became a little simpler a year ago when CPT Codes replaced four radiation therapy codes with a single code 77427 (radiation treatment management, five treatments). Nevertheless, the definition of this code contains nuances that might trip up unwary radiation oncology coders.
Coding radiation therapy management was much more complicated a couple of years ago, acknowledges Lynn C. Esposito, CPC, clinical practice specialist with Hunter Radiation Therapy at the Yale University School of Medicine. Having only one level of service where there used to be four is much easier to manage. But there are certain requirements within 77427 that can be confusing.
Code 77427 was created to describe the professional management component of weekly radiation treatments. The code is assigned once for every five treatments or fractions. Our patients usually come in once a day to receive radiation therapy, Esposito explains. After five of those sessions, or five days, we are able to assign 77427 once.
She notes that the five sessions do not have to occur in a single week. Often a patient will begin treatment on a Wednesday, and then have additional treatments Thursday, Friday, Monday and Tuesday, with Saturday and Sunday off. On the Tuesday, we would bill the five fractions with the previous Wednesday as the date the service was initiated.
Although each patient visit generally constitutes one treatment or fraction, Esposito says the treatment may encompass a number of variables. They may receive the treatment from more than one angle, for instance, or they may even be placed on more than one machine. None-theless, this constitutes one treatment.
Exceptions to this may occur when the specialist is treating patients for some cancers, including head and neck cancers involving sites such as the tonsils, base of the tongue and piriform sinus, according to Anu Gupta, MD, radiation oncologist with Georgetown University Medical Center in Washington, D.C. To treat these advanced-stage oropharyngeal and hypopharyngeal cancers, radiation is delivered to these sites as well as to the surrounding lymph nodes. The dose at each treatment is a little less but must be given twice a day, usually once in the morning and again later in the afternoon.
Even though they occur on the same calendar date, these two sessions are recognized as two treatment fractions, she says. Its medically necessary to deliver the treatment in this manner.
Esposito adds that these two treatments must be six hours apart to constitute two fractions. This is termed hyperfractions or BID for some payers, and providing that the medical necessity is documented in the patients treatment record, treatment management [...]
