Oncology & Hematology Coding Alert

Question: How should I report two 20 MeV radiation treatments on the same day if we treat the same three areas at each session? New Jersey Subscriber Answer: Under certain conditions, you can report two units of 77416 (Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greater) for Medicare patients. The rule: Medicare states that you may receive payment for multiple treatment sessions on the same day "as long as there has been a distinct break in therapy services, and the individual sessions are of the character usually furnished on different days" (Medicare Claims Processing Manual, chapter 13, section 70.3. For many carriers, a four- to six-hour break is sufficient to count as the required "distinct break." Units tip: If your payer allows only one unit of 77416 per line, you may need to report one unit of 77416 on one line and another unit of 77416 on a second line. You should append 76 (Repeat procedure by same physician) to the second code. Also, code 77416 indicates "three or more separate areas," and therefore one unit covers all three areas. Documentation matters: Be sure your oncologist documents the order, medical necessity and a prescription for two sessions in one day.