Oncology & Hematology Coding Alert

A 77435 bundling change lets your physician get paid for his work If your freestanding center has been struggling with stereotactic treatment coding edits, join the celebration that the National Correct Coding Initiative, version 13.1, deleted these troublemakers. The lowdown: Effective April 1 and retroactive to January, NCCI version 13.1 deletes edits bundling stereotactic treatment management codes with stereotactic treatment delivery codes, according to the American College of Radiation Oncology (www.acro.org/content/srs_coding.cfm).
Prepare to Resubmit Denied Claims With the deletion of these edits, you-ll be able to bill: 77432 (Stereotactic radiation treatment management of cerebral lesion[s] [complete course of treatment consisting of one session]) on the same date as 77371-77372 (Radiation treatment delivery, stereotactic radiosurgery [SRS], complete course of treatment of cerebral lesion[s] consisting of 1 session ...) 77435 (Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions) on the same date as 77373 (Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions). These edits have been a -big problem,- says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga. This edit didn't affect hospitals because they don't bill professional services, but it's been a problem for freestanding centers. Reason: Because stereotactic radiosurgery -is normally conducted in a single-fraction scenario,- you would typically bill physician management in the same session as the treatment, says Deborah Churchill, RTT, president of Churchill Consulting in Killingworth, Conn. So that set of NCCI edits was -an error,- she says. Good news: Because these edits will be deleted retroactively, you can resubmit any claims your payer denied since January. -Practices need to be ready to resubmit for correct payment,- Parman says. CMS won't automatically reprocess any denials, she adds. Benefit: CMS pays about $600 for 77435 and $400 for 77432.
Be Glad You Dodged This NCCI Bullet The originally proposed NCCI 13.1 edits included bundling radiation therapy management code 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) with stereoscopic x-ray guidance code 77421 (Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy). NCCI proposed allowing a modifier to override this edit. The American Society for Therapeutic Radiation Oncology (ASTRO) objected to this edit in a letter published at www.astro.org/PublicPolicy/CommentLettersTestimonyAndReports/documents/v131txtmngtigrt1106.pdf. As ASTRO's letter explains, a physician may sometimes treat a patient with non-stereotactic hypofractionated radiotherapy using one or two fractions (77431), and the target may be located near -critical structures.- The doctor may need to use stereoscopic x-ray guidance (77421) to -localize the target- before delivering this treatment, [...]