Oncology & Hematology Coding Alert

Question: Is it correct to charge for treatment management (77435) when the patient received three of the five planned stereotactic body radiation therapy (SBRT) treatment deliveries? Medicare LCD states “CPT^® code 77435 code will pay only once per course of therapy.” To me, this indicates that 77435 can only be billed when the patient completes the entire course.

AAPC Forum Participant

Answer: You are correct when you say that >Medicare will pay only once for a course of SBRT reported with 77435 (Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions).

But CPT^® guidelines for the radiation treatment therapy codes (77427-77499) state that “Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy sessions, and the fractions are of the character usually furnished on different days.” CPT^® Assistant confirms this when it states, “treatment delivery can consist of single or multiple treatment sessions up to five, generally at twenty-four hour intervals” (2015, Vol. 25, no. 4).