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POLICY

The Radiation Treatment Management codes in range 77427-77431 are used to report a radiologist's professional services provided during the course of radiation treatments. A radiologist's professional services include the following activities:

• Review of port films
• Review of dosimetry, dose delivery, and treatment parameters
• Review of patient treatment set-up
• Examination of patient for medical evaluation and management (e.g., assessment of the patient's response to treatment, coordination of care and treatment, review of imaging and/or lab test results)

Radiation treatment management is reported in increments of five fractions or treatment sessions. The fraction or treatment sessions do not have to be furnished on consecutive days. Code 77427 (Radiation treatment management, five treatments) should be reported after the completion of five fractions or treatment sessions. Span the service dates on code 77427 to include the first and last date of the five fractions or treatment sessions. Code 77427 should always be reported with one unit of service.

Code 77427 is also reported if there are three or four fractions or treatment sessions beyond a multiple of five at the end of a course of treatment. For example, if the patient's complete course of treatment includes eight or nine fractions or treatment sessions, code 77427 should be reported twice - once for the first five fractions and once for the three or four fractions beyond the first five (see Example #1 and #2 below).

One or two fractions or treatment sessions beyond a multiple of five at the end of a course of treatment should not be reported. For example, if the patient's complete course of treatment includes six or seven fractions or treatment sessions, code 77427 should be reported once with one unit of service. In this example, the sixth and seventh fractions or treatment sessions should not be reported separately. The dates of service should span all fractions or treatment sessions (see Example #3 and #4 below).

When the patient's complete course of treatment includes only one or two fractions, code 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) should be reported once. Span the service dates on code 77431 to include the first and last date of the treatment. Code 77431 should not be used to report one or two fractions in the last week of a long course of therapy (see Example #5 below).

• Example #1: The patient's complete course of treatment includes 9 fractions or treatment sessions

  Code	DOS	Units
  77427	2/10/04-2/20/04	01 (5 fractions or treatment sessions)
  77427	2/20/04-2/28/04	01 (4 fractions or sessions)

• Example #2: The patient's complete course of treatment includes 13 fractions or treatment sessions

• Code	DOS	Units
  77427	1/10/04-1/20/04	01 (5 fractions or treatment sessions)
  77427	1/22/04-2/04/04	01 (5 fractions or treatment sessions)
  77427	2/06/04-2/15/04	01 (3 fractions or sessions)

• Example #3: The patient's complete course of treatment includes 7 fractions or treatment sessions

  
  
  

  Code	DOS	Units
  77427	3/20/04-4/02/04	01 (7 fractions or treatment sessions)

• Example #4: The patient's complete course of treatment includes 11 fractions or treatment sessions

  Code	DOS	Units
  77427	5/02/04-5/12/04	01 (5 fractions or treatment sessions)
  77427	5/14/04-5/28/04	01 (6 fractions or treatment sessions)

• Example #5: The patient's complete course of treatment includes 11 fractions or treatment sessions
  
  

Code	DOS	Units
77431	3/02/04-3/06/04	01 (2 fractions or treatment sessions)

POLICY EXCEPTIONS

None

POLICY GUIDELINES

The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.

POLICY HISTORY

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