Radiation Treatment Management


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Code 77427, patient has daily radiation treatment and seen by MD weekly for radiation treatment management.


If MD sees patient on week 1 on a Wednesday for the above then on week 2 sees patient for the above on Tuesday, can we bill 77427 for the 1st week and 2nd week even though it less then 5 treatment days? :confused:

Many individuals have different opinions since Cancer Center drops their billing on a weekly basis therefore only one 77427 appears on bill. Would like an correct interpretation according to the below.

According to the Medicare Claims Processing Manual
Chapter 13 - Radiology Services and Other Diagnostic Procedures
Table of Contents
(Rev. 1998, 07-09-10)
Transmittals for Chapter 13

Carriers must pay for a physician's weekly treatment management services under code 77427. Billing entities must indicate on each claim the number of fractions for which payment is sought.
A weekly unit of treatment management is equal to five fractions or treatment sessions. A week for the purpose of making payments under these codes is comprised of five fractions regardless of the actual time period in which the services are furnished.


West Hills, CA
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"Radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days."

"Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately, as long as there has been a distinct break in therapy sessions."

That is the definition, accordinig to the CPT book.

What I would say, is the 5 units are sessions - and they are distinct from each other. Or, there has been a break between therapy sessions, and the sessions total 5.

If the patient is being seen for only one therapy session on that Wednesday .. and not being seen again until week 2 - on Tuesday ... then that only totals 2 therapy sessions.

If the MD saw the patient 5 times on Wednesday of the 1st week .. then "yes," you can bill this 77427 code. If the MD didn't ... then maybe speak with the MD, and let him know what that you can bill for the 77427 code .. but he has to have 5 separate therapy sessions with the patient. I believe, according to the definition ... all 5 therapy sessions can be administered in one day (there just has to be a distinct breat between them).