Oncology & Hematology Coding Alert

Learn about this new way to monitor medication use and efficacy.

In addition to all the new permanent and temporary test codes featured in the 2022 CPT^® release, a set of codes to document a new patient service — remote therapeutic monitoring (RTM) — and a revision to one of your most-used codes make up the main highlights of the manual’s current edition.

Here’s what you need to know prior to the implementation of these changes, which will occur on Jan. 1, 2022.

Get Ready for the New RTM Codes

The Medicare Physician Fee Schedule (MPFS) proposed rule for 2022 introduced a new concept that received full CPT^® code numbers in the recent update and that will come into play on Jan. 1, 2022. RTM may impact the field of oncology, so now may be a good time to learn about it and see if it might be a useful way to manage your patients who are on long-term drug therapy.

The codes in question are as follows:

• 98975 (Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment)
• 98976 (… device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days)
• 98977 (… device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days)
• 98980 (Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; first 20 minutes)
• +98981 (… each additional 20 minutes (List separately in addition to code for primary procedure))

What is Therapeutic Monitoring?

Essentially, RTM monitors health conditions, “including musculoskeletal system status, respiratory system status, therapy (medication) adherence, and therapy (medication) response,” according to the 2022 proposed rule. In other words, RTM services go beyond data collection to measure the efficacy of a given treatment on a patient’s condition. Because of that, RTM services “allow non-physiologic data to be collected,” the proposed rule continues.

In addition, RTM data “can be self-reported as well as digitally uploaded.” To do that, the patient must use a device that meets the FDA (Food and Drug Administration) definition of a medical device as described in section 201(h) of the Federal Food, Drug and Cosmetic Act (FFDCA), the proposed rule notes. This does not mean that the device has to be approved by the FDA. But it does mean the device has to be “recognized in the official National Formulary, or the United States Pharmacopeia, or any supplement to them” (Source: www.fda.gov/regulatory-information/search-fda-guidance-documents/classification-products-drugs-and-devices-and-additional-product-classification-issues).

Don’t Minimize This Office/Outpatient E/M Change

Another change slated to take effect on Jan. 1, 2022, is the deletion of the words “usually, the presenting problem(s) are minimal” from 99211, which now reads “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.”

“The deletion is an editorial revision to bring the descriptor for 99211 more into line with the rest of the office/outpatient evaluation and management (E/M) codes (99202-99215). Prior to 2021, all included a sentence that read, ‘Usually, the presenting problem(s) are....’ Now, they don’t,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

What this means: The change is more than a simple revision designed to realign the code to its larger group, however. “It also removes a potential source of confusion,” says Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas.

Removing the words acknowledges that the severity of the patient’s condition does not determine the E/M level necessary for the service you should report. “For instance, 99211 may be reported when a nurse provides education to a newly diagnosed cancer patient though cancer is by no means a minimal problem,” says Hughes, noting an example where the service being provided (the education) is low-risk and minimal with little data to be reviewed or analyzed, though the complexity of the problem is possibly higher.

In other words, even with the change, “99211 still represents an E/M (really an assessment and management) service provided by clinical staff as opposed to a physician or other qualified health care professional who may report higher levels of E/M services,” Hughes notes.

And Don’t Overlook These New Pneumococcal Vaccines

Last, as oncology patients are encouraged to stay protected from pneumonia, you should make note of the addition of two new pneumococcal vaccines to the CPT^® medicine code set: 90671 (Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use) and 90677 (Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use). However, you won’t be able to use 90671 right away, as it is still awaiting FDA approval.