radiation coding

[shelly1966]

Our hospital gave 4 treatments of radiation and the patient is going to another hospital for the 5th treatment. How would we go about getting reimbursed for the treatments we gave? it is my understanding that it is only billed every 5th treatment.
thank you!
Shelly Jones
CHONC, CCS

 

[sls314]

Our hospital gave 4 treatments of radiation and the patient is going to another hospital for the 5th treatment. How would we go about getting reimbursed for the treatments we gave? it is my understanding that it is only billed every 5th treatment.
thank you!
Shelly Jones
CHONC, CCS

Are you billing for the hospital or the physician?

The hospital can bill the appropriate treatment delivery code for all 4 days treatment was administered at the facility.

The physician can bill 1 unit of 77427 for the 4 fractions that they supervised at the facility.

While 77427 typically represents 5 fractions, it can be used at the end of treatment for 3 or 4 fractions. It cannot be used for one or two fractions. If only one or two fractions had been administered, 77431 would have been the appropriate code.

I assume that the planning and other services rendered before treatment began have already been billed. If not, you can bill those too.

 

[sls314]

When you say that the patient is going to another hospital, is that hospital part of your system and under the same tax ID? Or is it a completely different hospital system with services rendered by a completely different doctor.

I answered the physician question above under the assumption that the treatments at the next facility would be supervised by a different radiation oncologist at that facility.

I'd have to research further if the same radiation oncologist will continue to supervise the services at the other facility and under the same tax ID number. I suspect it would still be the same advice, because it's a different location. But I could research that in my reference materials and find the answer for sure, if need be. Just let me know!

 

[shelly1966]

Are you billing for the hospital or the physician?

The hospital can bill the appropriate treatment delivery code for all 4 days treatment was administered at the facility.

The physician can bill 1 unit of 77427 for the 4 fractions that they supervised at the facility.

While 77427 typically represents 5 fractions, it can be used at the end of treatment for 3 or 4 fractions. It cannot be used for one or two fractions. If only one or two fractions had been administered, 77431 would have been the appropriate code.

I assume that the planning and other services rendered before treatment began have already been billed. If not, you can bill those too.

Thank you so much!!!!

 

[shelly1966]

Thank you so much!!!!

4 treatments were done at my hospital and 1 will be done at a different facility not in our network by a different physician.
Thank you for all your help.