Noting When Radiation Therapy Is Twice Daily?

The opinion released by The Centers for Medicare & Medicaid Services (CMS) has said you can bill for twice-daily radiation therapy as long as the treatments happened in “different sessions.” But you have to be careful to follow the rules and avoid getting into trouble by billing for “different sessions” that were really just parts of the same session.

A procedure called “hyperfractionation” is defined as any technique of radiation treatment that delivers more than one treatment session per day. If you’re stumped how to make sure that a session is separate from another session, just know this: to be considered separate, two sessions should be at least six hours apart. This six-hour delay is important for the patient’s cells to recover. And ends one session and begins a new one for the second round of radiation delivered over six hours later.

As with much of your medical billing, documentation will go a long way towards getting your claims reimbursed. A good rule of thumb would be for the coder to be certain that the exact procedures that were done for the patient and to make sure the documentation backs it up.

In the end, if you file a medical billing claim and you want to count these as two sessions,just make sure that at least six hours passes between sessions and that your documentation backs up your coding.

View all Articles by: Kathryn Etienne, CCS-P