Oncology & Hematology Coding Alert

Question: An RN in our radiation department sees patients before their treatment. She does an assessment, which includes vitals and skin checks. She also teaches, takes cultures, performs dressing changes, etc. Sometimes, 30 minutes or more are spent. Are these visits included in the facility charge for the weekly management fee, 77427 (radiation treatment management, five treatments), or can she also bill a 99211 (office or other outpatient visit) for her services?

Utah Subscriber

Answer: The answer to this question depends on the setting. In a freestanding radiation center, in which the radiation oncology group employs the staff, the services provided by the nurse are included in the weekly treatment management fee. This fee covers all services related to the radiation therapy, including:

review of port films;

review of dosimetry, dose delivery and treatment parameters;

review of treatment setup; and

examination of patient for medical E/M, such as assessment of the patients response to treatment, coordination of care and treatment, review of imaging and/or lab test results.

In general, the radiation treatment management codes, 77427-77499, are meant to replace 99211-99215 for the E/M of patients undergoing radiation treatment. There are, however, occasions when a nurse may give injections or IV therapy. These procedures fall outside the parameters of 77427 and allow for separate codes to be used. For example, injections or IV therapy should be coded separately from 77427 as 90780 (IV infusion for therapy/ diagnosis, administered by physician or under direct supervision of physician). While the injection code is appropriate, it is important to reiterate that E/M codes are not.

On the other hand, when the radiation center is in the hospital and the nurse is employed by the facility, Ambulatory Patient Classifications (APCs) apply, which makes billing the domain of the hospital. The nursing visits can be billed using 99211-99215 with the criteria established by individual facilities.