Coding Corner: Bill So Many Radiation Treatments - In So Little Time

Understand nature of sessions and timing for same-day reporting

If you think you can't get paid for multiple same-day radiation treatments, think again. You can indeed report multiple radiation treatment sessions on the same day -- as long as you adhere to Medicare's guidelines.

According to CMS Program Memorandum A-03-020, "Codes 77401 through 77416 may be reported more than once per date of service only when radiation treatment is provided during completely different sessions." You can report only one of these codes for each treatment session no matter how many areas are treated or no matter how much radiation is delivered.
Look to 'Nature of the Services'
Although CMS does not define "completely different sessions," most Medicare intermediaries agree that the physician must maintain a six-hour break between the radiation treatments. And, the patient's medical record must clearly document the medical necessity of separate session scheduling (also referred to as "BID" or "hyperfractioning").
"You have to look at the nature of the radiation services," says Deborah I. Churchill, RTT, president of Churchill Consulting Inc., in Killingworth, Conn. For you to bill two radiation treatment codes, the separate sessions have to be services that the physician would normally perform on different days, she says.
 
Suppose the physician treats a patient in the morning with two separate areas, Churchill says. "This constitutes only one treatment delivery code because you would normally address both of these areas during one session."
 
In other words, if the physician administers two unique treatments to the patient on the same day, report two separate treatment encounters using the appropriate code(s).
For example, "If a patient had a head or neck cancer, such as T1 cancer of the larynx (161.0-161.9), you might administer a lower-than-normal dosage of radiation to the patient, but we do that twice a day," says Diane Corder, RTT, facility administrator at Gwinnett County Radiation Therapy Center in Lawrenceville, Ga.
"The per-treatment dosage is lower, but the overall dosage is higher than normal. The caveat: The insurer requires that we allow a minimum of six hours between therapies so the normal cells can recuperate." If the physician meets those requirements, you can report both codes on the same date.
Churchill agrees. "The standard 'BID' break, based on utilization guidelines, is approximately six hours." This technique is generally applicable for the following conditions:


lymphomas (202.xx)

head and neck tumors (195.0)

certain brain tumors in children, particularly those in the brain stem (191.7)

rapidly growing tumors not responsive to single daily fractions

malignant tumors of the genitourinary (184.x or 189.x) and respiratory system (165.x), as well as gynecologic malignant tumors (183.x) and progressive tumors [...]

- Published on 2004-05-17