Oncology & Hematology Coding Alert

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 [...]