Oncology & Hematology Coding Alert

Add to your understanding of what's in store for oncology and hematology in 2011.

The New Year is in sight, so there's no time like the present to start easing your practice into the CPT 2011 changes that will be in effect on Jan. 1, 2011. You can start your preparations with a look at some of the most important changes on the horizon.

Eye on the future: Advice and information about the new, revised, and deleted codes for 2011 should be clarified during the AMA's annual CPT and RBRVS Symposium, which takes place in November. Staff members from The Coding Institute and Codify  will be reporting directly from the event, so look to future issues of this publication for further information and instruction.

Prepare for Peritoneal Cavity Chemo Change

As reported in the last issue of Oncology and Hematology Coding Alert, current reports indicate that CPT 2011 will add new code 96446 (Chemotherapy administration into the peritoneal cavity via indwelling port or catheter).

This new code is important because CPT hasn't previously offered a code for chemotherapy via port without peritoneocentesis, says Kelly Loya, CPC-I, CPhT, managing consultant for Los Angeles-based Sinaiko Healthcare Consulting.

Instead, CPT 2010 offers 96445 (Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis), which specifically requires peritoneocentesis.

The new code "is clinically more accurate as to how physicians do this" procedure, says Melanie Witt, RN, CPC, COBGC, MA, an independent coding consultant from Guadalupita, N.M. That's because oncologists often don't perform peritoneocentesis with peritoneal cavity chemotherapy. As a result, coders have long questioned how to code this service properly. CPT Assistant (February 2009) stated that you should append modifier 52 (Reduced services) to 96445 when the physician doesn't perform peritoneocentesis, but experts note that payers' requirements vary.

Deletion alert: CPT 2011 will put the 96445 question to rest by deleting the code effective January 1.

Expect Changes to Intraperitoneal Cath Insertion, Too

You'll also have a new code for insertion of a tunneled catheter for intraperitoneal chemotherapy administration: 49418 (Insertion of tunneled intraperitoneal catheter [e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites], complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous).

CPT 2011 will delete similar code 49420 (Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary).

Several related codes will see revisions, including the following:

➤ 49324

• 2010: 49324 -- Laparoscopy, surgical; with insertion of intraperitoneal cannula or catheter, permanent
• 2011: 49324 -- Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter

➤ 49419

• 2010: 49419 -- Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)
• 2011: 49419 -- Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable)

➤ 49422

• 2010: 49422 -- Removal of permanent intraperitoneal cannula or catheter
• 2011: 49422 -- Removal of tunneled intraperitoneal catheter.

Add to Your Insterstitial Device Options

CPT 2011 also will bring changes to codes for interstitial device placement.

Laparoscopic: First, you'll have a new code for laparoscopic placement of interstitial devices in the abdomen, pelvis, or retroperitoneum: 49327 (Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Open: Second, CPT 2011 will add a new code for open placement of interstitial devices in the abdomen, pelvis, or retroperitoneum: 49412 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Note that both codes end with the instruction to "List separately in addition to code for primary procedure," suggesting these will be add-on codes. Revision: Prostate code 55876 will see a minor revision to change a reference to "percutaneous," Loya notes. Instead, the 2011 definition will refer to "via needle":

• 2010: 55876 -- Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, prostate, single or multiple
• 2011: 55876 -- Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple.

Focus on 57156 for Endometrial Cancer

You should also be aware of two brachytherapy-related code changes.

Code 57155 will see a minor wording revision, Loya says:

• 2010: 57155 -- Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy
• 2011: 57155 -- Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy.

You'll also have a new code to learn: 57156 " Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy.

"While we do not yet know the rationale behind all of these additions, the new code 57156 should be good news for gynoncologists who are separately inserting a vaginal device for the later application of brachytherapy as part of endometrial cancer treatment," says Witt, who specializes in ob-gyn coding. We will have to wait until the presentation at the symposium, however, to know the details of the work involved, she adds.

CPT 2011 Combines Abdominal/Pelvic CT

If your center performs its own diagnostic exams or needs to get pre-approval for your patient's tests, don't miss three new CT codes for 2011:

• 74176 -- Computed tomography, abdomen and pelvis; without contrast material
• 74177 -- ... with contrast material(s)
• 74178 -- ... without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

Current reports indicate that CPT will not be deleting the current abdominal CT and pelvic CT codes, so you'll have 74176-74178 in addition to the abdominal-only and pelvic-only codes. Look to future issues of Oncology and Hematology Coding Alert to bring you details on how the AMA intends you to use these codes.