Oncology & Hematology Coding Alert

For best results, think of "voluntary" as "mandatory."

Think you got off easy with the relatively minor updates to ICD-10-CM and CPT^® codes for 2018? It's a "really slow year for HCPCS II codes," says Cindy Parman, CPC, CPC-H, RCC, AHIMA Approved ICD-10-CM Trainer, who presented a coding update at the recent ACCC seminar in Richmond, Virginia.

But not so fast - CMS has added many new modifiers, and modifiers are notoriously tricky even for experienced coders and billers. With that in mind, you may be wondering if you really need to use those voluntary codes. The answer is a bit unclear - you don't have to use them, but you probably should.

So why bother training your staff to use modifiers that aren't required? First, it's good practice for when and if the codes become permanent. "Some are voluntary, some are mandatory, some we don't know when they are going to be mandatory," Parman says. The more you brush up during the voluntary period, the fewer denials you'll see when those modifiers are here to stay.

Another reason? "Medicare is all about the data right now," notes Parman. They are gathering data and we have to make sure we are giving them the right data, she continues. When CMS makes decisions, they are going to use the data from the people who actually submitted it.

If that doesn't include you, you are subject to whatever decision that arises based on other providers' data.

One of the major modifier additions that is voluntary for now is the set of patient relationship codes (X1-X5). This is "one of the biggest changes for physician billing that I think we've had in a long time," Parman notes. Billers and coders will need to know which one they'll use for each patient, and whether or not that code will ever change for that patient. Oncology patients tend to have a mix of continuous and acute care with several different providers, so "this isn't going to be as easy for oncology as it will be for other specialties," Parman says.