Radiology Coding Alert

Even though carriers refer to CPT 77427 (Radiation treatment management, five treatments) as a "physician's weekly treatment management," remember that this code includes five sessions, regardless of the actual treatment time period. In fact, CMS even allows you to count multiple fractions on the same day, as long as you document a break between treatment sessions. Report 77427 for 3-4 Treatments CMS considers the first five treatment sessions (or fractions) one unit of 77427. But you can report multiple fractions representing two or more treatment sessions that occur on the same day if "the fractions are of the character usually furnished on different days," and you document a break between treatment sessions, according to Section 15022 of the Medicare Carriers Manual. If you administer three or four additional treatments at the end of a treatment course, you can report a full unit of 77427. But if only one or two fractions remain, Medicare will bundle them into your prior radiation treatment payments, so you should not report them. For example, if you complete nine fractions during a patient's radiation treatment, you should report 77427 twice, once for the first five fractions and a second time for the remaining four. According to Jim Hugh, MHA, vice president of American Medical Accounting and Consulting, a coding and reimbursement consulting firm in Atlanta, radiation oncology practices commonly make three mistakes:
Billing for one or two remaining fractions using 77427
Using 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) for each of the remaining fractions
Allowing payers to steer them away from the proper use of 77427.   How to Use 77427 Radiation treatment management represents the professional services of the physician managing a radiation course. You don't necessarily have to provide these services on consecutive days. Code 77427 includes the physician's ongoing supervision and care of the patient during the entire course of radiation treatment, and each unit of 77427 includes:
Reviewing and revising the treatment plan
Reviewing port film or portal verification images
Reviewing chart and dosimetry, including the dosage you have administered to date, and treatment parameters
Treatment setup and positioning evaluation, immobilization device, and block placement review
Treating infected skin, with special attention on ostomy site
Writing medical prescriptions
Nutritional counseling, fluid electrolyte management
Telephone calls to or from the patient
Pain management.   According to the February 2000 CPT Assistant , you should not report an E/M code when you report 77427, because it includes your evaluation services. You should always wait until you administer at least five fractions before you [...]