Oncology & Hematology Coding Alert

Master CMS- long list of project G codes and earn an extra $23 per encounter

Oncology practices are buzzing about the 81 new codes associated with the 2006 demonstration project. CMS wants to track the quality and spectrum of cancer care, but you-ve got to learn how to code properly for the project to make it a success. Here's how to incorporate this project into your daily coding routine with ease.

The lowdown: CMS wants you to report G codes representing the focus of the visit, the relation of the treatment to current guidelines, and the disease status for particular cancer patients.

CMS- objective for the voluntary 2006 demonstration project is to base oncology payments on patient-centered care rather than chemotherapy administration, which may not require much doctor/patient interaction. CMS wants to look at the quality and spectrum of care patients receive and determine whether it represents best practice.

The project is open to oncology patients based on diagnosis, unlike the 2005 project, which focused on type of treatment, says Linda Gledhill, MHA, senior associate with oncology consulting firm ELM Services Inc., based in Rockville, Md. For the 2005 project, you reported codes representing chemotherapy patients- analysis of certain symptoms--nausea/vomiting, pain and fatigue. Pinpoint Suitable 2006 Project Patients The criteria: You may self-enroll in the project simply by reporting the appropriate G codes on a patient's claim. Just be sure you meet the following guidelines, according to the CMS release -2006 Oncology Demonstration Program: Improved Quality of Care for Cancer Patients Through More Effective Payments and Evidence-Based Care- (available at www.cms.hhs.gov/apps/media/press/release.asp?Counter=1717).

Here are the rules you need to know:
 
- Report the appropriate demonstration project G codes only for an office-based hematologist or oncologist.

- Use the G codes only when the physician provides an E/M service (levels 2-5) to an established patient; you should report the G codes in conjunction with the E/M code.

- Be certain that the established patient's primary diagnosis meets one of 13 major diagnostic categories:

- cancer of the breast (female; invasive)
- colon
- rectum 
- prostate
- lung (both small cell and non-small cell)
- stomach
- esophagus
- pancreas
- ovary
- head and neck
- chronic myelogenous leukemia
- multiple myeloma
- non-Hodgkin's lymphoma.

Report the Right G Code for Each Range
 
If you meet the above criteria, you then have to choose the appropriate G codes for your patient. The list can be quite imposing, Gledhill says.

Here's a breakdown of the code ranges you need to know:

- G9050-G9055 (Oncology; primary focus of visit ...). These codes are differentiated based on whether the oncologist provides a workup at the time of diagnosis, decision-making after staging, disease surveillance after therapy, management of a patient with cancer that isn't being treated, palliative care, or an unspecified service.

- G9056-G9062 (Oncology; [...]