Oncology & Hematology Coding Alert

Remember progress notes: You should also include a physician progress note for each "week" of therapy. In this example, append one progress note for the first "week" (five fractions) of treatment, and another for the final three fractions.
 
Don't take "week" literally: You do not necessarily administer a "week" of fractions on five consecutive days. With some patients, the oncologist may skip a day or two between treatments; other patients may require multiple fractions of radiation treatment management on a single date of service.

Report 77427 Once for Fewer Than 3 Fractions

However, if the same patient with upper-lip cancer received six fractions of treatment, you would report 77427 only once, says   Laurel L. Huebscher, CPC, with the University of Minnesota Physicians Radiation Oncology, Radiology, and Lab Medicine and Pathology.
 
Report code 77427 "if there are three or four fractions beyond a multiple of five at the end of a course of treatment," she says.
 
Truth: "But if there are one or two fractions beyond a multiple of five at the end of a course of treatment,  you should not report the fractions separately," Huebscher says.
 
Consequences: If you report 77427 x 2 for six or seven fractions of treatment, the insurer will almost certainly deny the claim.

Document Therapy Breaks on Multi-Fraction Days

With some cancer patients, your oncologist may have to deliver multiple fractions of treatment on the same date of service. You can count these fractions as separate treatment sessions - as long as you document a distinct break in therapy, Huebscher says. 
 
Who needs same-day treatments? "Reasons for multiple treatments per day are that the tumor size and location make the tumor inoperable, or the patient may have a very aggressive form of cancer in the head and neck area that the physician will treat" with multiple daily treatments, Huebscher says.
 
For example, a patient with lymphoma reports for radiation treatment. The physician administers two separate fractions treatment, one at 8 a.m. and the other at 2 p.m. If you document that six-hour break in therapy, you can count both sessions as separate fractions.

77431 Not for Leftover Fractions

When you encounter leftover fractions of radiation treatment, you may be tempted to use 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) to report the remainder. Experts warn against using 77431 for fraction remainders, because it will surely sink your fractions claim.
 
"If a patient has only one or two radiation treatments, you should bill 77431," Blekeski says.

For example, 77431 is appropriate for patients recovering from hip surgery who receive one treatment. (This treatment is also known as "postoperative heterotopic calcification." With these patients, the entire course of therapy consists of one or two fractions of radiation therapy.)
 
Others who may get 77431 treatment include: