Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

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Medical Oncology Code Changes

On-Treatment and Follow-Up Visits

Physicians report CPT procedure code 77427 for each 5-fraction week of radiation therapy treatment management, but do not report any separate evaluation and management (E&M) visits while the patient is on-treatment. In addition, once the patient has completed radiation therapy, follow-up visits provided in the office or freestanding center during the first three (3) months after therapy are included in the treatment management services already billed, based on guidance in the 2005 CPT Manual. This applies to treatment of the malignancy as well as any other conditions cared for while the patient was under therapy management (i.e., nausea, skin reaction, etc.).

For hospital reporting under the Outpatient Prospective Payment System (OPPS), there are also no E&M visit charges while the patient is receiving radiation therapy. CMS states that when a patient presents for a scheduled outpatient service (such as radiation treatment) there is typically no patient visit reported in addition to the procedure. The exception to this guideline would be a patient that received radiation therapy, but also had a patient visit in a separate, unrelated hospital department.

The difference for the hospital occurs with the follow-up visits: Follow-up patient visits for radiation therapy provided in the hospital outpatient department during the first three months following therapy are separately reported. This technical service is not considered to be included in any service previously charged, and can be billed.

Cindy C. Parman, CPC, CPC-Hcparman-1520862
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.  

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