Oncology & Hematology Coding Alert

Question: The oncologist orders two complex radiation treatments eight hours apart on the same date of service, using 20 MeV each time. Which CPT codes should I report and how many units?


New Jersey Subscriber


Answer: Unless your payer tells you otherwise in writing, 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).

Alternative: Some payers may only allow one unit of the treatment delivery code per line, so you may need to report 77416 on one line without a modifier and on a second line with modifier 76 (Repeat procedure by same physician). Don't use modifier 59 (Distinct procedural service) unless your payer tells you in writing to do so.

Rationale: Payers typically consider treatments at least six hours apart to count as two separate sessions. Some payers also require the sessions to be of the sort usually provided on different days.

Helpful: Keep supporting documentation on hand for the twice-a-day treatment: the doctor's order, a consult note detailing medical necessity, and a prescription order.