Oncology & Hematology Coding Alert

Question: Our office is receiving denials for 77427 because we did not specify a date range per code. If this information is not specified, they reduce the units to 0.2 (or two fractions) instead of paying the full one unit (or five fractions). Are we documenting incorrectly?

Minnesota Subscriber

Answer: There are a number of different filing requirements for 77427 (Radiation treatment management, five treatments). Radiation treatment management represents the physician's professional services managing a course of radiation therapy. Clinical treatment management is the ongoing management of a course of radiation therapy using any energy of photon beam or high-energy particle source.

Radiation treatment management is reported in units of five fractions or treatment sessions regardless of the actual time in which the services are furnished. The services do not need to be furnished on consecutive days.

Some payers require that only the first treatment date for the five-fraction segment be listed in the date field, while others require only the last date of the five-fraction segment. Still others insist that both the first and last treatment date for the five therapy sessions be listed as "from" and "to" dates.

Similarly, some payers require units of "1" for this treatment management service, whereas other insurers require that the actual number of treatments performed (e.g., 3, 4 or 5) be listed in the units field.

You should obtain payer guidelines in writing for this service and make certain to keep abreast of changes to these policies. Payment posters should also be alert to ensure that appropriate reimbursement is received and that overpayments or rejections are not an issue for this service.

The same is true if 77427 is used to report hyperfractions when more than one treatment session is performed per day. In most instances, two hyperfractions are done per day approximately four hours apart.

Because these fractions are related to the same treatment session, most payers consider two hyperfractions to be equal to one fraction. Consequently, 10 hyper-fractions should be performed before 77427 is reported.

According to CPT guidelines, multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately, if there was a distinct break in therapy sessions. Some payers, however, allow five hyperfractions for 77427 if the radiation oncology practice can prove the hyperfractions were related to separate therapy sessions. To bill 77427 for five hyperfractions, documentation in the progress note should show that the radiation oncologist examined the patient within each of the five hyperfractions.