Oncology & Hematology Coding Alert

If you’re using patient portals, you’ll rejoice at the inclusion of these new online codes.

You’ll find a total of 394 code changes in the 2020 CPT^® code set, including 248 new codes, 71 deletions, and 75 revisions — but not to worry. We’ve broken down which codes affect your oncology practice the most, so you can start learning them now.

CPT^® Gets Hip to the Times

As of Jan. 1, 2020, you’ll say goodbye to 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

Instead, you’ll report this service using the following new options:

• 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes),
• 99422 (… 11-20 minutes), and
• 99423 (… 21 or more minutes).

You’ll find similar codes for qualified nonphysician health care professionals (see new CPT^® codes 98970-98972, replacing 98969).

These codes reflect “this year’s important additions to CPT^®.” They came about because of “novel digital communication tools, such as patient portals, that allow health care professionals to more efficiently connect with patients at home and exchange information,” according to the AMA press release entitled “AMA Releases 2020 CPT^® code set” (URL:  www.ama-assn.org/press-center/press-releases/ama-releases-2020-cpt-code-set?fbclid=IwAR0F0v6UWRTVfYT-MCZGrbZekKa3sEA6hx75PzG1Iw2hDn7tRrQOLlqNnxo)

You’ll Find New Grafting Codes in the Integumentary Section

If your oncologist performs grafting for reconstruction purposes, then you should note the new grafting codes (15769-15774), which specifiy grafting of autologous soft tissue and fat.

Remember: “Autologous is tissue originating from the same individual who will receive the tissue from the patient’s own body,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, associate partner, Pinnacle Enterprise Risk Consulting Services LLC.

Take a Gander at These General Surgery Additions

Next time you go looking for chest wall excision codes, you’ll have to turn to the general surgery musculoskeletal section rather than the integumentary section. These codes (21601-21603) will specify excision of chest wall tumors including or involving rib(s).

You will also find Category III codes for ablation surgeries. They are:

• 0581T (Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral)
• 0582T (Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance).

Remember, when a Category III code exists to describe a service or procedure, you must use that Category III code — rather than an unlisted-procedure code — to describe the service when submitting a claim. So, why is this important?

Use category III codes for new procedures:  Category III CPT^® codes are temporary codes. “The need for these codes [arose] due to the development of new technology,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. “It may be a while before this service is rendered effective and covered.”

The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy.

Delve Into All of These Diagnostic Changes

You’ll have two new spinal puncture codes to choose from, as of Jan. 1. They are 62328 (Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance) and 62329 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance).

Radiologic examination codes 74022-74280 get an overhaul, so you’ll need to tread carefully if you’re reporting these codes in 2020. You’ll find revisions, deletions, and new codes. Most of these have to do with formalizing the “radiologic examination” part, and then specifying the anatomical location with the inclusion of barium. “This may be of interest to oncologists,” Loya says.

“What’s of more interest,” Loya points out, “are the deletions/revisions/new codes dealing with single photon emission computed tomography (SPECT).”

First off, you’ll say goodbye to brain imaging SPECT (78607), cerebrospinal fluid flow SPECT (78647), and kidney imaging morphology SPECT (78710) codes. These codes will no longer be valid as of January 1.

Then, you’ll revise the following codes (emphasis added):

• 78800 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); limitedplanar, single area (eg, head, neck, chest, pelvis), single day imaging)
• 78801 (… multipleplanar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days)
• 78802 (… planar, whole body, single day imaging)
• 78803 (… tomographic (SPECT), single area (eg, head, neck, chest, pelvis), single day imaging)
• 78804 (… planar, whole body, requiring 2 or more days imaging).

Similarly, you’ll delete the radiopharmaceutical localization of inflammatory process codes (78805-78807).

Next, you’ll add the following new codes:

• 78830 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging)
• 78831 (… tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days).
• 78832 (…tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days).

Comb Through These Pathology Additions

Next, you’ve got a lot of new laboratory codes to learn. These Therapeutic Drug Level labs include new codes for Adalimumab (80145), Infliximab (80230), and Vedolizumab (80280).

You should also familiarize yourself with the PALB2 (partner and localizer of BRCA2) codes 81307-81308 and PIK3CA code 81309.

Speaking of genes, you’ll also find gene expression profiling codes for breast cancer (81522), prostate cancer (81542), and uveal melanoma (81552). Note: You’ll delete gene expression profiling of solid organ neoplasia code 0057U and uveal melanoma mRNA code 0081U.

Heads up: July 1st and October 1st brought some other new lab codes that will appear in your 2020 CPT^® manual including 0084U, 0089U-0092U, 0101U-0104U, 0111U, 0113U, 0120U-0123U, and 0129U-0138U.

Plus: You also have a lab related Category III code, which is 0564T (Oncology, chemotherapeutic drug cytotoxicity assay of cancer stem cells (CSCs), from cultured CSCs and primary tumor cells, categorical drug response reported based on percent of cytotoxicity observed, a minimum of 14 drugs or drug combinations).

Don’t Forget About the New Flu Vaccine Code

As with every year, you’ll find a new flu vaccine code: 90694 (Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use). This code goes into effect January 1, 2020.

Currently, the codes available for flu vaccines are below, as noted by Lori Carlin, CPC, COC, CPCO, CCS, director of professional coding services at Pinnacle Integrated Coding Solutions:

Note: This chart is located in this MLN Matters Document:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19022.pdf.