Oncology & Hematology Coding Alert
Identify, Breakdown Services
Chemoembolization should block blood from flowing to tumors not block your cash flow. Know when to report this procedure, which additional codes to include and what to expect from payers to prevent impeded reimbursement. Use Diagnosis,Report to Identify the Procedure Transcatheter arterial chemoembolization (TACE) is a relatively new procedure, so you may still need help to identify it accurately and quickly. Look for the diagnosis code to help figure out whether the physician performed this procedure, says Yvonne Almanza, RHIT, a coder at The Methodist Hospital in Houston. The procedure treats liver cancer either originating in the liver (155.0) or metastasized from another part of the body (for example, 197.7). You should also look for other indicators in the operative report, such as the acronym TACE. Read the report closely for other words, including "injection" and "islet cell transplant," Almanza says. Code Cocktail: Embolization, Angiography, Selections No one code describes both the embolization and chemotherapy injection, so you have to report these two codes for chemoembolization, Stanley says: Do not report separate codes for chemotherapy infusion, she says. The chemotherapy infusion codes 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type ...) and 75896 (Transcatheter therapy, infusion, any method ... radiological supervision and interpretation) do not accurately describe the procedure. You use these latter codes for chemotherapy infusions without embolization. Report Preprocedural Diagnostic Angiography If your physician performs a "medically necessary" angiography one that determines whether to use the embolotherapy or documents the tumor distribution for diagnostic reasons you should report 75726 (Angiography, visceral, selective or supraselective ... radiological supervision and interpretation), Almanza says. But if your physician performs a preprocedural angiography just for "road-mapping" (planning the embolotherapy) you cannot separately report the angiogram because it's included in the radiological interpretation and supervision (RS&I) code. Include Selection Codes In addition to medically necessary angiography codes, you should report appropriate selection codes for when the physician selects the artery. If your physician takes multiple views without catheter repositioning, do not report other surgical or RS&I codes. Complete Report With Complete Angiography If your physician performs a complete angiogram after chemoembolization, you should report 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion), Stanley says. "Code 75898 is used to report angiography after infusion therapy or transcatheter embolization therapy," she states. Check Payer Policy for Real You hear it over and over again, but this time, you should listen: Check with your local carrier's guidelines for reporting chemoembolization.
During chemoembolization, the physician injects, directly into the hepatic artery, three chemotherapy drugs that saturate the tumor, stopping blood flow and thereby depriving the tumor of oxygen and nutrients, says Belinda Stanley, CPC, CIC, at Medical Asset Management in Atlanta. The starved tumor soaks in a very high concentration of drugs for a prolonged period of injection, causing the cells to die quickly, she says.
37204 Transcatheter occlusion or embolization percutaneous, any method, non-central nervous system, non-head or neck
75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation.
But you can report additional codes for medically necessary preprocedural diagnostic angiography, artery selections and completion angiography services. When you report these additional services, do not append modifier -51 (Multiple procedures) unless your carrier requests otherwise. Most carriers add this modifier on their own when necessary.
Select a code from the 36245-36248 range (Selective catheter placement, arterial system ...), Almanza states, for example, 36246 (... initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the physician catheterizes the common hepatic artery and injects contrast. Report 36247 (... initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) instead for embolizations of the proper hepatic artery.
If the physician moves the catheter to other arteries, such as the left hepatic artery, and injects contrast, report only one unit of highest-order vessel catheterized, in addition to:
+36248 ... additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate) for each additional vessel catheterization; and
+75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure) for each additional vessel studied in the same vascular family.
Medicare doesn't have a national coverage policy, and reimbursement varies widely among commercial insurers. BlueCross/BlueShield (BC/BS) of both Massachusetts and North Carolina, for example, covers chemoembolization only on a case-by-case basis. BC/BS of Massachusetts does not cover chemoembolization for the treatment of cancer but does consider it appropriate, in some cases, for relieving pain or pressure from hepatoma or symptom relief for neuroendocrine tumor or carcinoid. The carrier goes on to advise physicians about what patient information to submit for case-by-case coverage consideration.
Aetna, on the other hand, does cover chemoem-bolization for several liver cancer conditions, as long as the patient meets certain criteria. For example, patients with unresectable, primary hepatocellular carcinoma (155.0) must have encapsulated nodule(s) of less than 4 cm in diameter, a serum bilirubin concentration under 2.9 mg/dl, a serum creatinine level under 2.0 mg/dl and no extra-hepatic metastasis to justify reimbursement. Other payers may require preauthorization for chemoem-bolization, and you could lose $2,000 if they deny your claim for not following this and other coverage guidelines So request your payers'guidelines in writing before reporting this procedure.
Oncology & Hematology Coding Alert
- Dont Let Special Handicap Your Payment:
Show Payers Dynamite Documentation
What's so special about your physician's work? If payers can't answer this question from your [...] - Increase Pay by 18 Percent:
Maximize Incident-To
Just a change in identification and the right documentation and payers will see a higher-paid [...] - Report This Tricky Example Incident-To
Check your incident-to coding skills: How would you report this shared E/M service? The nurse [...] - Ace TACE Payments:
Identify, Breakdown Services
Chemoembolization should block blood from flowing to tumors not block your cash flow. Know when [...] - You Be the Coder:
New Zevalin Codes
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Reader Question :
Use This List for Unlisted Procedures
Question: What documentation must I have to report an unlisted-procedure code, such as 96549 (Unlisted [...] - Reader Question :
Rake In the Green With CADD Pumps
Question: What is a CADD pump, and how should I code for it? Mississippi Subscriber [...] - Reader Question :
For Uncertain Neoplasm Behavior, Specify Site
Question: The physician's documentation shows a neoplasm with uncertain behavior of the female genital organs. [...]
