Looking for Billing information for Radiation Oncology CPT 77427

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Montgomery
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I am new to radiation oncology and would like to get some opinions on how you are billing the code 77427? The system that was put in place prior to my working in this facility is that it is automatically dropped after the 5th fraction and billed on that date. There is no "through" date. From what I have read about this code, we should have a "global" like period of dates (e.g. from 1/1/2016 to 1/5/2016 and there should be 5 units for these dates of service as long as 5 fractions were done on each day.) Is this correct?

Thanks for any input on this!
 

mhoschar

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Lee, FL
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77427

I am new to radiation oncology and would like to get some opinions on how you are billing the code 77427? The system that was put in place prior to my working in this facility is that it is automatically dropped after the 5th fraction and billed on that date. There is no "through" date. From what I have read about this code, we should have a "global" like period of dates (e.g. from 1/1/2016 to 1/5/2016 and there should be 5 units for these dates of service as long as 5 fractions were done on each day.) Is this correct?

Thanks for any input on this!
You can only bill a 77427 on the DOS within those 5 FX in which the doctor performed the Weekly Ontreat Visit, it should be billed on the date he did the ontreat visit happened. Example if a patient has 32 FX you should have been able to bill 6 77427 during that time frame. IF a patient has 33-35 FXs during their course of treatment you can bill up to 7- 77427 charges.
Hope that helps answer you question.
 

daragan

Contributor
Local Chapter Officer
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through date for 77427

With all payors except Medicaid our practice bills a begin and end date for each set of five treatments provided. The provider is required to see the patient on a least one of those treatment days and document that he has seen the patient. We do document on the claim the five dates entailed. Medicaid wants only one date for the billing date but we still do note on the claim all five dates involved. You can bill only three days if it is at the end of treatment. Also months can't overlap so you need to pick the month that has the most dates and put that in as your range of dates. Then again note all the dates on the claim.
 
Messages
11
Location
Montgomery
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Thanks!

With all payors except Medicaid our practice bills a begin and end date for each set of five treatments provided. The provider is required to see the patient on a least one of those treatment days and document that he has seen the patient. We do document on the claim the five dates entailed. Medicaid wants only one date for the billing date but we still do note on the claim all five dates involved. You can bill only three days if it is at the end of treatment. Also months can't overlap so you need to pick the month that has the most dates and put that in as your range of dates. Then again note all the dates on the claim.
Thank you for your information!
 

sudeep1988

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You can only bill a 77427 on the DOS within those 5 FX in which the doctor performed the Weekly Ontreat Visit, it should be billed on the date he did the ontreat visit happened. Example if a patient has 32 FX you should have been able to bill 6 77427 during that time frame. IF a patient has 33-35 FXs during their course of treatment you can bill up to 7- 77427 charges.
Hope that helps answer you question.




Its goood need to check 5 multiple
 

rachaelwilleford

Networker
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31
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Carencro, LA
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77427

Our practice has billed 77427 in the following manner for all payors except Medicaid: 77427 is dropped on the 5th treatment day during which time the physician performs an on-treatment-visit. Medicare (Novitas) requires a global period, so we file according to Medicare guidelines. On the claim, the dates of treatment are included in additional claim information. Medicaid in our state requires a date span rather than the latter form of billing. Some of the managed care Medicaid plans prefer the Medicare billing. The only time you can bill less than 5 treatment days is at the end of treatment, of which needs to be noted on the claim in additional information as well. I have had to fight with Humana over that.

Hope this helps!
 
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