Radiology Coding Alert

Question: How many radiation therapy sessions are included in a weekly treatment code? Washington Subscriber Answer: CPT Codes provides one code for the professional management component of weekly radiation treatments: 77427 (Radiation treatment management, five treatments). The code is assigned once for every five treatments or fractions. Since cancer patients usually come in once a day to receive radiation therapy, 77427 is assigned after five sessions, or five days, are completed. Within each five-fraction segment, the radiation oncologist must document at least one progress note indicating the patient's current condition, the continuation of or alteration to the treatment plan and other key information. The five sessions do not have to occur in one calendar week (e.g., Monday through Friday). The patient may begin treatment on Thursday and have additional treatments on Friday, Monday, Tuesday and Wednesday. On Wednesday, the practice bills five fractions, with the previous Thursday noted as the date service was initiated. Even if patients receive complex treatment (e.g., radiation originating from more than one angle or if they are placed on more than one machine), each patient visit constitutes only one treatment or fraction.

Exceptions occur with a few rare cancers, like head and neck cancers involving sites such as the tonsils, base of the tongue and piriform sinus. Radiation oncologists treat these advanced-stage cancers with radiation delivered to the diseased sites and the surrounding lymph nodes. The dose at each treatment is less, but must be given twice a day, usually in the morning and later in the afternoon. Even though they occur on the same calendar date, these two sessions are recognized as medically necessary, and payers generally consider them as two distinct treatment fractions. These two treatments must be six hours apart to constitute two fractions. This is termed "hyperfractions" or "BID" for some payers and, if the medical necessity is documented in the patient's treatment record and the radiation oncologist documents progress notes for each five-fraction segment, treatment management is reimbursed for each ofthe five treatment fractions. Therefore, for hyperfractionated treatment, this may equal two 77427 codes billed for five calendar days of therapy. Reader Questions were answered and reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists; Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas; and Gary Dorfman, MD, FACR, FSCVIR, past president of the Society for Cardiovascular and Interventional Radiology (SCVIR) and president of Health Care Value Systems in North Kingstown, R.I.