Oncology & Hematology Coding Alert

Question: The guidelines for 77427 say you may report the code for five fractions -- and for three or fourfractions beyond a multiple of five at the end of treatment. How do we report this? Separate claims? Use a modifier?

Massachusetts Subscriber

Answer: You should report the services only after the oncologist completes the set of five therapy sessions (or the last three or four sessions beyond five). You should not need to report a modifier. But the dates you use vary by payer.

Option 1 (most common): Report the first date of the five-fraction treatment segment as the date of service.

Option 2: Report the last date of the five-fraction treatment segment as the date of service.

Option 3: Report the first and last dates of the fivefraction treatment segment as a range for the date of service.

For example: Your payer asks you to use the first date of the five-fraction segment as the date of service. A patient has treatments on April 6, 7, 8, 9, 13, 14, 15, and 16. On or after April 13 (the fifth treatment), you submit a claim for 77427 to reflect management for April 6 to 13 with April 6 as the date of service. On or after April 16 (the final treatment), you submit a 77427 claim with April 14 as the date of service. This claim covers management for April 14 to 16.

Be sure you have documentation of a physician-patient visit during the first five fractions and the final three in this example to bolster your claim.