Advanced Search

Oncology & Hematology Coding Alert

Demo Project Aim:

Added Comfort for Chemo Patients

Published on Sat Jan 01, 2005

Participating practices can earn added reimbursement from Medicare

CMS is ringing in the New Year by giving oncology offices a chance to collect some extra reimbursement when treating patients with chemotherapy.
 
How? By applying new G codes to track your chemotherapy patients' symptoms and having patients fill out a special symptom form, you could earn your practice up to an extra $130 per encounter from Medicare in 2005.

CMS Concerned With Pain, Nausea, Fatigue

On Jan. 1, CMS will launch a demonstration project that will run for the calendar year 2005. The project will offer Medicare a chance to "assess and provide new support for the quality of care for cancer patients undergoing chemotherapy," CMS said in a November news release.
 
The project will focus on "measuring patient outcomes in three areas of concern often cited by patients undergoing chemotherapy: controlling pain, minimizing nausea and vomiting, and reducing fatigue," according to the release.

Project Could Affect Future Chemo Coding

Coding experts contend that Medicare's aim with this project is to re-evaluate the amount of work involved when your office provides assessment service to a chemotherapy patient.
 
"In addition to the administration of chemotherapy, the medical staff must assess the patient [for levels of pain, nausea and fatigue] before each treatment, and currently there is no separate reimbursement for this assessment," says Cindy Parman, CPC, CPC-H, RCC, president-elect of the AAPC National Advisory Board and co-founder of Coding Strategies Inc. in Dallas, Ga.
 
"These three assessment areas require [a lot of] time and resources, so CMS is 'tracking' patient-reported levels of pain, fatigue and nausea - potentially to determine if there will be an overall increase in chemotherapy administration services," Parman says.

Patients, Bottom Line Can Benefit

One benefit of participating in this project is the ability to better track symptoms in your patients. "These G codes can be tracked internally, and practices will be able to give themselves a report card on how well a patient's side effects of pain, nausea/vomiting, and fatigue are controlled," Parman says. (And don't forget Medicare's offer of extra reimbursement for program participants.)
 
How do I enroll? If your office decides to take part in the program, enrollment is easy: All you have to do is include the new G codes for pain assessment and the Rotterdam Symptom Checklist (RSCL) when you file your chemotherapy claim.
 
"By billing the designated [G] codes, the practitioner will self-enroll in the project," according to CMS. (For more information on the Rotterdam Symptom Checklist, see "Know How to Use the Rotterdam Symptom Checklist" on page 5.)
 
Example: Let's say a Medicare patient with cancer reports to the office for chemotherapy. Before the chemotherapy session begins, the patient should fill out the RSCL to report his symptoms.
 
On his RSCL, the patient records level-one nausea, level-two pain, and level-three fatigue. The oncologist then delivers chemotherapy to the patient via subcutaneous injection. On the claim, demonstration project participants should:
 

  • report G0355 (Injection, chemotherapy, non-hormonal) for the chemotherapy. (This is the code for chemotherapy administration that Medicare   wants reported in 2005. Do not report  96400 [Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia] for the chemotherapy session.)
     
  • report G9021 (Chemotherapy assessment for nausea  and/or vomiting, patient-reported, performed at the time of chemotherapy administration; assessment level  one: not at all [for use in a Medicare-approved demonstration project]) for the patient's nausea.
     
  • report G9026 (Chemotherapy assessment for pain, patient-reported, performed at the time of chemotherapy administration, assessment level two: a little [for use in a Medicare-approved demonstration project]) for the patient's pain.
     
  • report G9031 (Chemotherapy assessment for lack of energy [fatigue], patient-reported, performed at the time of chemotherapy administration, assessment level  three: quite a bit [for use in a Medicare-approved  demonstration project]) for the patient's fatigue.  
     
  • submit the RSCL as an addendum to the claim.               
     
    Remember: You must use the new G codes on every chemo claim you're filing for the demonstration project, and you should include proof that the patient reported the assessments of nausea/vomiting, pain, and lack of energy/fatigue for every patient.
     
    Once you enter three new G codes in conjunction with each chemo encounter - that's one per patient status factor - your office will be eligible for an extra $130 per encounter, according to the CMS release.

    Make Sure Patient Reports Symptoms

    If you want to give your office every chance of getting that $130 carrot with every demo project claim, you may want to make sure the patient reports her symptoms on the RSCL. Parman says demonstration project forms with the patient's symptoms filled in by a physician or nurse might not fly with Medicare.
     
    "I think the biggest problem we have encountered with practices so far is that they want to determine how the patient is feeling, and these factors are to be 'patient-reported' by definition" when using the Rotterdam scale, Parman says.
     
    Best bet: Call your local Medicare carrier to ask about their policy on physicians or nurses reporting chemotherapy patient's symptoms; the carrier may require the RSCL to be filled out by the patient.
     
    Note: Interested in enrolling in the Medicare demonstration project? Oncology Coding Alert has everything you need in this issue. For a list of the new G codes you should report to Medicare, see "Clip and Save: Here's Your List of Demonstration Project G Codes" this issue.

    • Other Articles in this issue of

    Oncology & Hematology Coding Alert

    View All