Oncology & Hematology Coding Alert

If you suspected that the new brachytherapy needle placement codes that CPT 2008 introduced would be subject to the same Correct Coding Initiative (CCI) edits as the prostate and breast needle placement codes, give yourself a gold star.

The latest version of CCI spares almost no specialty, with more than 8,000 new edits that will affect claims in 2008. However, many of these edits are marked with a modifier status indicator of "1," which means you can override them with a modifier when appropriate, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

CCI version 14.0, effective Jan. 1, 2008, clarifies how coders should report the following three new needle and catheter placement codes:

- 20555 -- Placement of needles or catheter into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure)

- 41019 -- Placement of needles, catheters or other device(s) into the head and/or neck region (percutaneous, transoral or transnasal) for subsequent interstitial radioelement application

- 55920 -- Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application.

If you-re reporting one of those codes, the new coding edits warn you against reporting any of these codes in addition:

- 36000 -- Introduction of needle or intracatheter, vein

- 36410 -- Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)

- 37202 -- Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive)

- 62318-62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid ...

- 64415-64417 -- Injection, anesthetic agent ...

- 64450 -- Injection, anesthetic agent; other peripheral nerve or branch

- 64470-64475 -- Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...

- +69990 -- Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)

- 90760 -- Intravenous infusion, hydration; initial, 31 minutes to one hour

- 90765 -- Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to one hour

- 90772 -- Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

- 90774 -- - intravenous push, single or initial substance/drug

- +90775 -- - each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure).

Key: These edits are not surprising, experts say, when you consider that all of these codes are also already bundled with the needle or catheter placement codes for the prostate (55875) and breast (19296-19298).

CCI has marked these as nonmutually-exclusive (or column 1/column 2) edits. The column 2 procedures are normally included as part of the comprehensive column 1 procedures (in this case, 20555, 41019 and 55920) and should not be reported separately.

Most of these edits are marked with a modifier status indicator of "1," which means you can override them with a modifier when appropriate.

Exception: The bundling of 69990 into 20555, 41019 and 55920 is marked with modifier status indicator "0," which means that under no circumstances can you report the use of an operating microscope separately from those procedures. In fact, CCI 14.0 bundles 69990 into 73 CPT codes, most of which are codes introduced in CPT 2008.

Similarly, CCI 14.0 bundles more than 75 new CPT codes into intravenous infusion codes 90760 and 90765, as well as therapeutic, prophylactic or diagnostic injection codes 90772, 90774 and 90775. Since they are marked with modifier status indicator "1," you may override most of these edits when appropriate.

Biggest bundle: New neonatal initial hospital care code 99477 is bundled into a whopping 418 codes, says Frank Cohen, CMPA, of CPA Health Partners in Clearwater, Fla.

If you report 99477 with therapeutic apheresis codes 36511-36516, therapeutic injection codes 90772-90774 or scores of radiation oncology codes, Medicare carriers will reject the 99477 charge. And 141 other codes (including almost all of the E/M codes) bundle into 99477 and are therefore not separately payable if you report them with neonatal initial hospital care.

Also: CCI 14.0 bundles venipuncture code 36410 and needle or intracatheter introduction code 36000 into more than 75 other codes, most of which are also new in 2008. You can override most of these edits with a modifier.

CPT code 36415 (Collection of venous blood by venipuncture) is now bundled into critical care and intensive care E/M codes 99291-99300.

Watch for: The new edits do not include 36000 as a component of new codes 36591 (Collection of blood specimen from a completely implantable venous access device) and 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified) -- however, CPT 2008 instructs you not to report either of those new codes in conjunction with any other service.

Another new code, 90769 (Subcutaneous infusion for therapy or prophylaxis [specify substance or drug]; initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site[s]) includes the following:

- 64450 -- Injection, anesthetic agent; other peripheral nerve or branch

- 90772 -- Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

- most of the E/M codes.

CCI 14.0 has also paired 90769 in "mutually exclusive" edits with 96401-96402 (Chemotherapy administration, subcutaneous or intramuscular ...), meaning that you would not normally perform those services together.

With the exception of the minimal established patient visit code, 99211, you can override all of the 90769 edits with a modifier.

Replacement bundles: New code 36593 (Declotting by thrombolytic agent of implanted vascular access device or catheter), which replaces deleted code 36550, has all the same bundles 36550 used to -- except now, 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter]) is the column 1 procedure, with 36593 bundled into it.