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Oncology & Hematology Coding Alert

Here's Why NCCI Bundles G0338-G0340 With Radiation Treatment Codes

Published on Mon Aug 23, 2004

But you can use modifiers to separate these oncology-related edits

Radiation oncology coders who report new codes G0338-G0340 with basic dosimetry calculations should now append a modifier to 77300 to ensure accurate coding and to prevent denials.

Thanks to version 10.2 of the National Correct Coding Initiative (NCCI), Medicare and other payers will deny your 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) claims if you bill them with the new G  codes for robotic stereotactic radiosurgery without appending a modifier.

Bundling G0338 with 77300 and other radiation oncology codes (77290, 77295, 77321, 77336 and 77370) is a logical edit, says James E. Hugh III, MHA, ROCC, senior vice president of American Medical Accounting & Consulting in Atlanta. That's because NCCI already bundled these same radiation codes with G0242 (Multi-source photon stereotactic radiosurgery [cobalt 60 multi-source converging beams] plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment) years ago.

CMS introduced codes G0338-G0340 for 2004 because there were no codes that denoted stereotactic radiosurgery using a linear accelerator, as opposed to cobalt 60-based SRS (covered by codes G0242-G0243). Medicare reimburses roughly $1,450 for G0338 (planning), $5,250 for G0339 (first session or single-session treatment) and $3,750 for G0340 (second through fifth sessions).

And remember: Coding regulations allow only hospitals to report G0242-G0243 and G0338-G0340, not freestanding centers, Hugh says.

Learn Other Radiation Oncology Edits

NCCI 10.2 institutes dozens of radiation oncology edits, including one that bundles G0338-G0340 (... stereotactic radiosurgery...) into 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session). Because this edit features a "0" indicator, no modifiers can separate the edit. "A daily intensity modulated radiation treatment (IMRT) would not be expected on the same day as the stereotactic radiosurgery (SRS) codes," says Deborah Churchill, RTT, president of Churchill Consulting Inc., a medical reimbursement consulting firm in Killingworth, Conn. "Therefore, it is appropriate that 77418 and G0340 cannot be reported on the same day."

NCCI also bundles the following radiation oncology codes into G0338-G0340:

  • 77280-77290 - Therapeutic radiology simulation-aided field setting .... Insurers only bundle these codes when you perform the simulations the same day that you report G0338-G0340.

  • 77295 - Therapeutic radiology simulation-aided field setting; three-dimensional. You should report either SRS or 77295, but never both services.

  • 77300 - Basic radiation dosimetry calculation ...
  • 77305-77321 - Teletherapy, isodose plan (whether hand or computer calculated)...; 77326-77328 (Brachytherapy isodose plan ...). Insurers always include these services in 3-D and SRS plans.

  • 77332-77416 - Radiation physics, treatment delivery codes.

  • 77432 - Stereotactic radiation treatment management of cerebral lesion(s) (complete course of treatment consisting of one session).

    NCCI Bundles J2001 Into Hundreds of Codes

    If your practice reports J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) for lidocaine when your nurse gives iron or thrombin injections, expect a flood of denials starting July 1. Most payers bundle lidocaine payment into your injection fees. But you shouldn't use J2001 for injections anyway, because the J code describes an "intravenous infusion," not an injection.

    What the edit means: The new NCCI edit confirms that practices should never bill J2001 unless a physician treats a patient for cardiac arrhythmia.

    History: HCPCS deleted J2000 (Injection, lidocaine HCl, 50 cc) this year and introduced J2001 in its place. Although most oncology coders accurately took this as a sign that Medicare never intended them to use these codes for local anesthesia or nerve blocks such as for pain management, some coders simply changed their claim forms and started billing J2001 with every lidocaine injection.

    NCCI's version 8.1 bundled J2000 into several injection codes, which seemed to stop many oncology practices from billing lidocaine with such codes as 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular). At the time, Georgia Medicare's lidocaine policy stated, "The dosage indicated by the code [J2000] description is specific to the treatment of cardiac arrhythmias and emergencies only. The billing of J2000 is not appropriate for the 1-2 cc usually required for a local anesthetic."

    But when HCPCS introduced J2001, the new code breathed new life into the lidocaine debate for many practices. NCCI 10.2 shuts the door on any ambiguity, bundling J2001 into hundreds of codes.

    "The injection of a 'caine' while doing a joint injection is for pain control and shouldn't be billed separately," says Denise Paige, CPC, president of the American Academy of Professional Coders' Long Beach Chapter. "There are those who think that this never should have been billed separately in the first place, and after J2000 was deleted, I think that further backs up that theory."

    Edits Also Target Nuclear Medicine

    NCCI also hits nuclear medicine, bundling the radiopharmaceutical tumor localization codes 78800-78802 into 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion). The new edits also bundle the imaging codes 78185 (spleen), 78195 (lymphatics and lymph nodes), 78201 (liver) and 78215 (liver and spleen) into both 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) and 79403.

    You can use a modifier to separate these edits if the physician performs the services during separate sessions and your documentation proves that they were both medically necessary.

    Note: Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.



     

     

     

     

     

     

     

     

     

     




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