NEWS YOU CAN USE: NCCI 12.1 Will Limit How You Report Drug Administrations

• CMS Reinstates Drug Admin NCCI Edits
The Centers for Medicare & Medicaid Services (CMS) is reinstating drug administration National Correct Coding Initiative (NCCI) edits as of April, Transmittal 896 announces.
CMS had suspended application of the NCCI edits for OPPS drug administration codes to allow hospitals sufficient time to incorporate a series of coding changes that were being implemented into their systems. Because the drug administration NCCI edits support correct coding and are “appropriate for the coding of hospital outpatient services,” CMS ended the suspension period in April.
You can visit www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp for a list of the NCCI edits that you should be using after April 1. You can also go to www.cms.hhs.gov/HospitalOutpatientPPS/Downloads/OPPSGuidance.pdf to review a list of drug administration questions and answers and find links to the NCCI portion of the CMS Web site.
• CMS Clarifies How You Should Report IMRT Under Hospital OPPS
If you have to report intensity modulated radiation therapy (IMRT), also known as conformal radiation, you’ve most likely been confused on what codes you should use.

Thanks to the CMS April 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS), you don’t have to be confused any more.
CMS received several inquiries “seeking clarification of the appropriate billing of certain radiation oncology services when such services are performed in conjunction with an IMRT planning service,” according to MedLearn Matters article 5011. Transmittal 896 answers that question and others on how you should report IMRT services in a hospital outpatient setting.
You should use 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) to report IMRT treatment planning.
CMS clarified that you should not report codes 77280-77295, 77305-77321, 77331, 77336 and 77370 when hospital staff performs these services as part of developing an IMRT plan. In other words, don’t report 77280-77295, 77305-77321, 77331, 77336 or 77370 along with 77301.
When physicians perform these services as part of developing an IMRT plan, CMS considers the charges for these services to be included in the charge for 77301, even if the individual services occur on a different date of service than the date for which you’ll report 77301.
Tip: You can report 77332-77334 (Treatment devices, design and construction ...) with 77301 when your facility provides the services on the same day.
When you report 77301 and 77334, however, you’ll need to append modifier 59 (Distinct procedural service) to 77334 to indicate that the services were separate.
CMS also instructs that you should report 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated [...]

- Published on 2006-05-16