A Guide to Optimizing Reimbursement for Treatment of Gynecological Cancers
Published on Tue Aug 01, 2000
Coders who work in practices that treat gynecological oncology are familiar with the limitations of existing CPT Codes for cancer surgeries. There are too few codes, and they do not describe the variety of procedures currently in use to excise cancer, which makes it difficult to code for the services performed in the operating room. Additionally, due to the complex nature of cancer surgeries, coders often have difficulty determining which procedures are included or bundled into a code, and which can be coded and billed separately.
When it comes to gyn oncology coding, the question most often asked is, What is included? Coders need to know what they can and cant bill for per the available CPT surgical codes, says Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator.
When codes are assigned to the operative reports for cancer surgeries, Katie McClure, RHIA, surgical coder at Southeastern Gynecologic Oncology, an outpatient surgery center with five physicians in Alpharetta, Ga., says that the reports often describe extensive debulking procedures in which the physician excises multiple tumors or performs several procedures in the same operative setting. I find that a good rule to go by is always to read the body of the operative report to determine exactly what was done. For example, our physicians perform retroperitoneal dissections often. The op report helps me determine what they actually did before I assign the code did they excise disease, or was it just an exploratory procedure?
A Problem of Too Few Codes
As surgical techniques for cancer removal advance, many complain that new codes are not being introduced quickly enough to keep up with the changes. Another problem is the lack of codes to describe any gynecological cancer other than ovarian malignancies. For instance, some women have endometrial cancer (182.0, malignant neoplasm of body of uterus; corpus uteri, except isthmus [includes endometrium]). The surgical techniques for removing this type of cancer are very similar to those used to remove ovarian cancer. Yet the ovarian cancer codes cannot be used (they would be rejected by the carrier without a diagnosis of ovarian cancer), and procedure codes specific to uterine (the endometrium is the lining of the uterus) cancer dont exist, Witt explains. Obviously, this makes coding for endometrial cancer or other uterine cancers a challenge. The only codes specific to genitourinary cancer are those for ovarian malignancy. With other cancers, coders need to find the CPT codes that are the closest approximation of what was done in the operating room, says [...]
