Oncology & Hematology Coding Alert

Chemotherapy and radiation oncology CPT codes remain largely as they did in the 2000 edition. Codes for care plan oversight (CPO) for home health (99374-99375) and hospice (99377-99378) will be replaced by temporary codes added to HCPCS 2001, and a new code for the collection of blood from an implantable pump or port (36540) will also be added.

Most of the oncology-related changes will clarify code usage and make it more understandable to physicians. The changes reflect language that more closely match the way physicians practice medicine, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies, a coding consulting firm based in Dallas, Ga.

Definition Revised for 77470

One of the changes includes revised language to 77470 (special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, vaginal cone irradiation]). The new version defines 77470 as special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation). Endocavitary or intraoperative cone irradiation replaces the term vaginal cone irradiation. The revision reflects a definition more closely resembling language used by radiation oncologists in describing and planning treatment, Parman says.

The revised language, however, does not affect how physicians determine the level of radiation treatment management. For example, in addition to daily or weekly patient management, 77470 still requires that the procedure be performed one or more times during therapy.

Care Plan Oversight Changes

Further changes set for 2001 affect CPO, now 99374 and 99375 for home health, and 99377 and 99378 for hospice. The Health Care Financing Administration (HCFA) has released two new CPO codes to replace those found in CPT 2000. Physicians will have to bill CPO using the 2001 HCPCS code G0181 and G0182, new temporary codes. G0181 will apply to home health patients, and G0182 will apply to hospice patients.

While the codes have changed, the requirements related to using them have not, says Nancy Cothern, business manager at Baptist Cancer Institute in Jacksonville, Fla. For example, Palmetto Government Benefits Administrator, a Medicare payer, offers the following directives to its Medicare providers when using these new codes:

The beneficiary must require complex or multidisciplinary care modalities requiring ongoing physician involvement in the patients care plan.

The beneficiary must receive Medicare-covered home health agency (HHA), hospice or nursing facility services during the period in which the CPO services are furnished.

The physician billing CPO must be the same physician who signed the home health or hospice care plan.

The physician must furnish at least 30 minutes of CPO within the calendar month for which payment is claimed and no other physician has been paid within that calendar month.

The physician must provide a covered physician service that requires a [...]