This is part 2 in a series of billing blogs, highlighting some common mistakes and ways you can utilize features in the advanced billing software, Iridium Suite, to minimize mistakes and identify potential billing issues.
In the first issue I discussed bundled codes. You can see that article here.
In this issue, we will look at proper billing procedures for CPT code 77427. This is one of the most used and often most confusing codes in Radiation Oncology billing. Part of the confusion lies in the definition and part is due to payer inconsistencies regarding billing requirements.
77427 is defined as: Radiation treatment management, five treatments. You can also bill 77427 for 3-4 treatments performed at the end of a treatment course. You cannot bill for 1-2 treatments performed at the end of a treatment course.
Our tools can be your guide on properly billing 77427:
Scenario 1: 77427 = 5 radiation treatments
A built –in scrubber rule counts each radiation treatment delivery code and after each five,
the user is prompted to capture the 77427.
An automatic billing note is generated detailing the date range and number of treatment fractions. You can also program the date span to be hidden to satisfy payer requirements.
Scenario 2: 77427 = 3-4 treatments at the end of treatment
When the user completes a treatment course in the patient’s chart the scrubber initiates. It looks for the number of treatments since the last 77427 and if it finds 3 or 4,
the user is prompted to capture the 77427.
The automatic billing note is generated detailing the date range, number of treatment fractions, and that is it the end of treatment.
Scenario 3: 77427 ≠ 1-2 treatments at the end of treatment
When the user completes a treatment course in the patient’s chart and the scrubber initiates and it finds 1 or 2, it will not suggest to bill 77427.
The scrubber will also initiate if a user manually enters 77427 and warn if less than 5 treatments have been performed and the course is not complete.
Each of these scenarios is addressed with the built-in scrubber and complemented by Code Overrides to hide date spans as needed. The code Override can also be configured for those payers that like to see the number of fractions represented as number of units on the claim.
Reduced reimbursements and denials are inconvenient and hinder cash flow. Billing that can result in overpayments or billing for non-reimbursable treatment management services can get you and your practice scrutinized for all of your billing practices. We can help you to keep from going down that road.
Before it’s too late, learn more with a free Iridium Suite Practice Management Software demonstration.
