Oncology & Hematology Coding Alert

Question: How should our oncology practice code for more than five fractions in a radiation treatment?

Delaware Subscriber

 
Answer: When billing for treatment management in radiation oncology, practices should report 77427 (Radiation treatment management, five treatments) for five fractions at a time. You should report 77427 again if three or four treatment sessions remain. For example, if your radiation oncologist completed nine fractions prior to the end of a patients throat cancer (149.0, Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx; pharynx, unspecified) treatment, you would use 77427 once for the first five, and a second time for the remaining four. According to CPT, treatment sessions typically include review of port films, patient treatment set-up and dosimetry, dose delivery and treatment parameters, examination of patient for medical evaluation and management such as assessment of the patients response to treatment, coordination of care and treatment, review of imaging and/or lab test results.
 
But you are not allowed to bill one or two additional fractions separately. For instance, if your oncologist completes six fractions before the end of a patients treatment, then your practice should bill 77427 only once and absorb the costs for the additional treatment session. Some radiation oncology offices incorrectly assume that they can bill 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) for one leftover fraction. Use 77431 only when an entire treatment consists of one or two sessions.