Oncology & Hematology Coding Alert

For correct billing, be sure to include a separate treatment delivery code along with the insertion code.

In the 2017 OPPS proposed rule, CMS added 25 new C-APCs. Several of these were brachytherapy insertion/device codes. Commenters noted that claims for some of these codes did not include a corresponding treatment delivery code. As a result, they felt that treatment/delivery charges were not fully considered when the rates were set for the C-APCs. Commenters requested combination insertion/delivery codes, to aid in accurately reporting these codes together and valuing them appropriately.

CMS response: In last year's 2017 OPPS final rule, CMS denied commenters' request for combined insertion and treatment delivery codes. Their reasoning? It's your responsibility to pay attention and code correctly. CMS also said they would continue to examine claims for the seven brachytherapy insertion codes to determine if future adjustments might be warranted.

What's new: After continuing to review claims throughout 2017, CMS planned to implement a code edit that would require treatment code whenever an insertion code is billed. But that proposal didn't make it into the 2018 OPPS final rule.

What this means for you: Mistakenly omitting the treatment code means lost revenue. There won't be a denial to alert you, you'll just remain unpaid for a service you performed. Since there is no edit to remind you to include a brachytherapy treatment delivery code with these insertion codes, your coders must be vigilant. "If you don't bill it, it's your own fault," says Parman. If you use "claim scrubber" software, you can also set up your own edit to make sure you bill a delivery code (77750-77799) along with the insertion code.