Coding Question: Can the radiation oncologist bill the radiation management CPT® code 77427 without performing the "Hands-on," "Face-to-face" weekly examination? The nurse practitioner performs the weekly exams and the doctor will review her dictation and co-sign the dictation. Is the weekly exam satisfied if the radiation oncologist greets the patient in the hall, waiting room or verifies treatment setup in the treatment room?
Coding Answer: A nurse practitioner or physician assistant cannot bill for CPT code 77427 and physicians can only bill for services they perform. Radiation treatment management requires a minimum of one examination of the patient by the physician for medical evaluation and management per each reporting of CPT 77427. It may not be appropriate because of privacy concerns to examine a patient in the hallway or waiting room. In addition, the physician also performs other cognitive and technical activities that may include review of port images, dosimetry, dose delivery, treatment parameters and patient set-up, among other professional services as clinically indicated. Overall, these functions support the physician’s continual assessment of the manner in which treatment is delivered as well as the patient’s response to, and tolerability of, treatment.
Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2015, American Medical Association. All Rights Reserved.
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