Medicare Compliance & Reimbursement
RADIATION THERAPY ~ Think You Can't Bill For Radiation Therapy Twice A Day? Think Again
Double your reimbursement by noting when radiation therapy is twice daily. The Centers for Medicare & Medicaid Services (CMS) has said you can bill for twice-daily radiation therapy as long as the treatments happened in "different sessions." But you have to be careful to follow the rules and avoid getting into trouble by billing for different sessions that were really just parts of the same session.
Blue Cross Blue Shield of Florida defines "hyperfractionation" as any technique of radiation treatment that delivers more than treatment session per day, notes Cindy Parman with Coding Strategies in Atlanta.
Important: To be considered separate, two sessions should be at least six hours apart, says Deborah Churchill with Churchill Consulting in Killingworth, CT. This six-hour delay is important for the patient's cells to recover and associated radiation biological effect (RBE) from the second fraction, she says.
In some cases, the time between fractions may be as short as four hours, notes Parman.
Read your doctor's documentation carefully, Churchill adds. The doctor should call for treatments "BID," which means twice a day. Sometimes, the doctor may even order treatments "TID," which means three times a day, says Parman. The doctor will make this notation as part of the patient's treatment plan (CPT codes 77261-77263), Parman adds.
Also, the doctor will usually call for somewhat lower levels of "daily fractionation" if the patient is receiving radiation therapy more than once per dy, says Churchill. A standard daily treatment is around 180 centigray or greater, but a twice-daily treatment will be more like 100 to 140 centigray.
The coder should also report what the providers did, Parman adds. "The therapist, physicist, dosimetrist and other members of the radiation care team will have already reviewed the physician's order and planned the treatment accordingly," she explains.
Even though coders refer to management code 77427 as a "weekly" management code, you can bill it once per five fractions the patient receives. So if the patient receives 10 fractions in a given week, you could bill 77427 twice in one week. But you must make sure the doctor has seen and examined the patient during that period, warns Churchill. Your documentation must include an "on-treatment" visit note, she adds.
Medicare Compliance & Reimbursement
- MID-TERM ELECTIONS ~ SCHIP, Part D To Get Extra Attention From Democratic Majority In Congress
Many industry groups think the new Democratic Congress is a boon for health care. The [...] - PHYSICIANS ~ Reforms For Your Medicare Payments Could Happen Late In New Congressional Session
Democratic landslide means Congress may let your payments slide. It could be March, or even [...] - REHAB THERAPISTS ~ You Could Lose Big Money In 2007 -- Unless Congress Steps In
New fee schedule and therapy caps spell bad news for your reimbursement. Not only will [...] - HOME HEALTH CARE ~ Medicare Managed Care Likely To Become Lawmakers' New Financing Pincushion
Democratic election victory good for home care. Home care providers may be out of the [...] - REIMBURSEMENT ~ Some Specialties Reap Massive Pay Increases, Others Suffer
Women could lose out from the new practice expense payments. Some services will see drastic [...] - PART B ~ You Can Obtain A DME Billing Number To Bill For Oral Medications
Don't throw away money for anti-emetic, immunosuppressive drugs. If you're confused about whether you can [...] - RADIATION THERAPY ~ Think You Can't Bill For Radiation Therapy Twice A Day? Think Again
Double your reimbursement by noting when radiation therapy is twice daily. The Centers for Medicare [...] - INDUSTRY NOTES ~ Look Out For Dual Radiology Billing
Plus: Suppliers must go beyond CMN, court says. The Part B carriers are putting in [...]
