Oncology & Hematology Coding Alert

New oncology-related codes for 2002 top the list of significant changes in the Correct Coding Initiative (CCI) 8.0, which went into effect Jan. 1, 2002, and remains active until March 31, 2002. The edits require radiation oncology practices to bundle a number of codes (see below) with the new IMRT codes: 77301 (intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) and 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).
 
Also, although CPT 2002 treats bone marrow aspiration (38220) and bone marrow biopsy (38221) as separate procedures, CCI bundles them. They may be separately reported if it is documented that the two procedures are distinctly separate, meaning they were performed on separate days or separate sites. 
 
What was initially thought to be a move in a positive direction for radiation oncology practices is now looking like less of a blessing, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., in Dallas, Ga. Rather than allowing practices to bill 77301 and facilities to bill 77418 in addition to other related procedures, such as physician treatment planning (77261-77263), Medicare edits will disallow separate payment unless modifier -59 (distinct procedural service) is appended to the codes that accompany IMRT codes (listed below). Some will disallow any attempt at unbundling.
 
The following procedures that are performed on the same day by the same provider are among the codes that are bundled with 77301:

  CAT scans 70450-70492; 71250-71270
  Computed tomographic angiography 70496-70498
  Three-dimensional plan 77295 (modifier -59 exempt)
  Physician treatment plan 77261-77263 (modifier -59 exempt)
  Special dosimetry planning 77331 (modifier -59 exempt)
  Treatment devices 77332-77334
  Physics 77336-77370 (modifier -59 exempt)
  Special treatment procedures 77470 (modifier -59 exempt).

 Codes that should be bundled with 77418 include:
  Office or outpatient visit 99201-99211
  Hospital observation service 99218-99220
  Hospital inpatient services 99221-99238
  Follow-up inpatient consultation 99261-99263
  Confirmatory consults 99271-99275
  Radiation treatment delivery 77401-77416.
 All of the above codes are modifier -59 exempt.