Oncology & Hematology Coding Alert

Question: What exactly is hyperfractionation?

Pennsylvania Subscriber

Answer: Hyperfractionation is any technique of radiation treatment that delivers more than one treatment session per day. Hyperfractionation is usually twice and occasionally three times per day treatment separated by a period of at least four to six hours, according to AMAs CPT Assistant (Fall 1991).

Payers typically will consider payment for both treatments when you meet the four- to six-hour break requirement. For example, Highmark Medicares local coverage determination for radiation therapy services states, Multiple treatment sessions on the same day are payable 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.

Be sure to watch for reporting instructions. Highmark also indicates that when more than one treatment is performed on the same day, e.g., hyperfractionization, each treatment should be billed on a separate detail line (www.highmarkmedicareservices.com/policy/mac-ab/l27515-r6.html).

Tip: Highmarks LCD also states that 77470 (Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) is appropriate for the additional physician effort and work required for hyperfractionation.

\But verify you have the documentation to support this code. Some cases may not require the additional planning time and effort 77470 describes.