Oncology & Hematology Coding Alert

New code 38222 means you no longer have to worry about this old edit.

January 1, 2018 has come and gone, and you should already be adhering to the latest Correct Coding Initiative (CCI) version 24.0 edits. You have a few oncology edits to apply and one to cross off. Here's what you need to know for accurate claims.

Ogle These Oncology Radiation Additions

CCI 24.0 includes an edit bundling treatment device codes 77332-77334 into 77423 (High energy neutron radiation treatment delivery, 1 or more isocenter[s] with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator[s]). The modifier indicator of "0" means you cannot unbundle any of these edits with a modifier for any reason. None of these codes are new.

Neutron treatment code: Your physician may treat certain diagnoses such as salivary gland tumors (C08.9,  Malignant neoplasm of major salivary gland...) using neutron beam radiation, although neutron treatment is rare because it is so expensive. CPT^® created 77423 specifically for neutron beam treatment delivery.

Break down the treatment device codes: On the other hand, you'll use the treatment device codes 77332-77334 to "aid in the proper delivery of radiation to a target site and protect healthy tissues," says Angie Paine, consultant at Pinnacle Healthcare Consulting.

The trick to identifying the right treatment device code is to understand the definitions of simple, intermediate, and complex devices. The definition of code 77334 mentions the treatment device must be labeled complex while code 77332 (Treatment devices, design and construction; simple [simple block, simple bolus]) and code 77333 (Treatment devices, design and construction; intermediate [multiple blocks, stents, bite blocks, special bolus]) identify simple and intermediate respectively.

So what do these three terms mean? Each term describes varying levels of complexity for devices used during an oncology treatment. Simple usually refers to devices which can be used on a number of patients including devices like non-custom boluses, vaginal cylinders, breast boards, and prostate templates. Intermediate refers to devices like bite blocks and testicular shields. Complex indicates the device used was specific to an individual patient like a face mask, a multi lead collimator, or a custom-made bolus.

CCI 24.0 therefore prevents reporting these treatment device codes in addition to the neutron beam treatment code 77423.

Rejoice for this Modifier Indicator Change

You can now apply a modifier (such as, 59, Distinct procedural service) to the edits bundling A9539 (Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries) into 78815 (Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh) and 78816 (...whole body). Previously, no modifier was allowed. However, make sure your documentation meets the criteria for using the modifier.

Strike Out This Edit, Thanks to New Code 38222

As of January 1, you no longer have to worry about the CCI edit bundling 38220 (Diagnostic bone marrow; aspiration(s)) and 38221 (...biopsy(ies)). You could've applied a modifier to this edit (such as, 59), but you now have a new code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)) to take care of combination procedural coding.