Oncology & Hematology Coding Alert

Question: Ive just started coding radiation oncology and heard the oncologist can bill an E/M for the patients weekly assessment in addition to daily treatments. Is there any guidance supporting this?

Illinois Subscriber

Answer: You should not report an E/M for the weekly assessment. But you may report 77427 (Radiation treatment management, 5 treatments) for the physicians service.

AMAs CPT Assistant (Feb. 2000) states that 77427 covers everything from the simple cases (weekly exam and prescription writing) to complex cases (daily exams, managing side effects from nausea to infection to radiation-induced cystitis and beyond, as well as reviewing labs and imaging, and coordinating with other health professionals and support services, and more).

CPT Assistant also states you should not report E/M separately when reporting 77427 because radiation treatment management guidelines explain that 77427 includes medical evaluation and management.

Remember: When you have documentation of a visit, you should report 77427 once per five treatments, regardless of the actual time period the services are furnished in (it could be more or less than a calendar week).

You also may report 77427 for the last three or four fractions beyond a multiple of five at the end of treatment, providing that there is documentation of a physician-patient encounter during these final fractions. So if the patient has nine treatments, you may report 77427 for the first five and 77427 for the last four. But you should not report one or two fractions beyond a multiple of five separately.

Caution: The hospital also should not charge an E/M service for the patient on-treatment visit during radiation therapy. Nurse services are included in procedures or treatments performed the same day.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past president of the AAPC National Advisory Board.