(CPT CODE - 77427)
As of January 1, 2001, the weekly radiation treatment management code was introduced to replace CPT codes 77420 (simple), 77425 (intemediate), 77430 (complex), and 77419 (3-D conformal). This code does not require a “26” modifier.
It is the responsibility of the Radiation Oncologist to oversee the treatment management of the patient on a weekly basis. A progress note must be completed as part of the documentation of the patient’s treatment record. The date of the progress note is not the date used to bill a weekly management code. If there are 6 weeks of treatment, there must be 6 weeks of progress notes. The physician must examine the patient in an exam room or doctor treatment room (not in hallway). It must contain the following criteria:
1. Port Film Review
2. Chart & Dosimetry Review
3. Treatment Setup & Positioning Evaluation
4. Documentation of medical evaluation and progress of treatment
Nutritional counseling, pain management, care of infected skin, special care of ostomy and lab work is also included in 77427 and is not charged separately.
A nurse or non-physician practitioner should not complete the progress note for each patient encounter.
Radiation therapy management, 77427 includes the patient follow-up visit within 90 days of the completion of the patients’ treatment.
BILLING TIP
One treatment session equals one fraction. For every five fractions, one 77427 may be billed. This holds true except for the last week of treatment where one 77427 can include anywhere from 3 – 7 fractions.
You may not bill a weekly management code 77427, until the 5th treatment has occurred. It is totally based on the number of treatments, NOT the time lapse in dates.
The first day of the 5 fractions is the date you will bill the 77427. ALWAYS USE THE FROM DATE.
Every 5 treatments = one 77427
DO NOT FORGET THE FINAL WEEK OF TREATMENTS!
Example 1: Patient had 15 treatments
11, 14, 15, 16, 17, 18, & 21
You would bill:
5/8/06 77427 (5 treatments)
5/15/06 77427 (4 treatments)
Example 2: Patient had 12 treatments
You would bill:
5/8/06 77427 XF* (7 treatments)
Example 3: Patient had 18 treatments
You would bill:
5/8/06 77427 (5 treatments)
5/15/06 77427 (5 treatments)
5/22/06 77427 XF* (3 treatments)
*The XF modifier stands for final billing of the treatment course. Check with the Medicare carrier to see if this rule still is in effect. According to the Empire Medicare Services, “Radiation Therapy” billing guideline booklet you cannot exceed the number of units “5”. Other carriers want the actual number of units in the last week, which can be 3 – 7 units. Other carriers across the country use the last day of the week. You must remember that each carrier may have their rules that need to be followed.
