Oncology & Hematology Coding Alert

Get a sneak peek at what's coming down the CPT pike

The rules for coding stereotactic radiosurgery (SRS) are getting more specific all the time -- and you can't afford to miss a single development. These two updates will help you file clean claims at top speed.

1. Keep 77321, 77336 Off G0173 Claims

The National Correct Coding Initiative (NCCI) version 12.2 added two new radiation oncology edits on July 1.
 
Important: Both edits involve G0173 (Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session). Code G0173 reflects a -technical service- only --it describes the actual application of the radiation (similar to delivery codes 77407-77416).
 
Translation: There is no professional component for this service, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.
 
Only hospitals use G0173, so if you code for a physician or freestanding center, these edits won't apply to you, she adds. Exception: Your freestanding center may have negotiated G0173 use with managed-care insurers, though most negotiated rates use 61793 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator], one or more sessions), Parman says.
 
G0173-77321 edit: Code 77321 (Special teletherapy port plan, particles, hemibody, total body) is now a column 2 code to column 1 code G0173. The edit has a modifier indicator of -1.-
 
Rule: Column 1/column 2 edits describe -bundled- procedures. That is, CMS considers the code listed in column 2 as the -lesser- service, which is included as a component of the more extensive column 1 procedure, says Michael Weinstein, MD, of Washington, D.C., a former member of the AMA's CPT advisory panel.
 
If you were to report bundled (column 1/column 2) procedures for the same patient during the same session, Medicare would reimburse only for the higher-valued of the two procedures. Example: Now that 77321 is bundled into G0173, Medicare will only send payment for the latter code.
 
A -0- indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines.
 
A -1- means you may use a modifier to override the edit if the procedures are distinct from one another. -CMS recognizes -distinct services- when the two procedures are performed at separate patient encounters or on different (non-contiguous) body areas,- Parman says.
 
G0173-77336 edit: Code 77336 (Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy) is also now a column 2 code to column 1 code G0173 and has a modifier indicator of 1.
 
Rule of thumb: CMS G codes typically include all of the services required for the described procedure, Parman says. These edits reinforce that when you report G0173, this code incorporates all the services involved in performing stereotactic radiosurgery in a single session. Remember: These codes fall under local contractor jurisdiction. CMS develops G codes, so your private payer may not accept them.

2. Prepare for Possible 77432 Descriptor Change

When the CPT Editorial Panel met in Las Vegas on June 9-10, the American Society for Therapeutic Radiation Oncology presented a proposal to revise the descriptor for stereotactic radiation treatment management code 77432 (Stereotactic radiation treatment management of cerebral lesion[s] [complete course of treatment consisting of one session]) to allow treatment of more areas of the head.
 
Physicians have been using stereotactic radiation to treat all areas of the brain, says Santa Monica, Calif., oncologist Michael Steinberg, MD.
 
Code 77432 now refers to -cerebral- rather than -cranial.- Translation: You should only use the code for services related to the top part of the brain.