Oncology & Hematology Coding Alert

Oncology-related changes in CPT 2002 include a number of new codes for radiation oncology and some minor revisions to existing codes. The additions and revisions generally serve to clarify definitions or to assign codes to procedures that were previously reported with temporary G codes.
 
What remains to be seen is how CMS and private payers will respond to the revisions and whether the changes will affect their fee schedules. Oncology practices should begin preparing now for the changes, which go into effect Jan. 1, 2002.
 
"Preparation should include updating encounter forms to reflect the new codes," says Paula Stinecipher, CPC, CPC-H, co-founder and vice president of AlphaQuest, a healthcare services firm based in Atlanta. She also stresses that oncology practices should check their local medical review policies to determine whether the changes no matter how minor translate into revised coverage. 

Intensity-modulated radiotherapy (IMRT) is now reported using G0174 for the planning of each session and G0178 is for the delivery, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a coding consulting firm in Dallas, Ga., that advises a number of radiation oncology practices.
 
The new codes that will replace these are:

77301 intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications

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.

Examples of situations when IMRT is covered include tumors of the prostate; head and neck; and brain and paraspinal regions where it is important to reduce the incidence and severity of radiation side effects, such as compromised visual function, mucositis and xerostomia.
 
Required criteria for IMRT coverage include the following:
 

The target volume is irregularly shaped and close to critical structures that must be protected.
 

The volume of interest is in such a location that its parameters can only be defined by magnetic resonance imaging (MRI) or computerized tomography (CT).
 

Important structures adjacent to, but outside of, the volume of interest are sufficiently close to the margin so IMRT is required for additional safety and morbidity reduction related to radiation.
 

An immediately adjacent area has been irradiated, and abutting portals must be established with high precision.
 

Tumor volume margins are concave and close to critical structures.
 

The tumor tissue lies in areas associated with target motion caused by cardiac and pulmonary cycles, and the IMRT is necessary to protect adjacent normal tissues.
 

Non-IMRT techniques would cause grade-two or grade-three radiation toxicity in greater than 15 percent of radiated cases.
 

It is the only option to cover the volume of interest with narrow margins and protect immediately adjacent structures.
 

Only IMRT can produce dose distributions that can cover extremely concave target geometries.                                        

A new code for the placement of a vascular transcatheter used during brachytherapy is included primarily to give cardiologists a code to report prior to a radiation oncologist performing brachytherapy (the use of radioactive seeds, needles, liquids or tubes).

92974 transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (list separately in addition to code for primary procedure).

It should not affect how the radiation oncologist reports the brachytherapy procedure. In most cases, the physician bills for high-dose brachytherapy (77781-77784), Parman says.

Insertion of uterine tandems and vaginal ovoids, as part of brachytherapy treatment, was reported using 77799 (unlisted procedure, clinical brachytherapy). Use of the Heyman capsule, which is inserted in the uterus, was also reported using an unlisted-procedure code. There are now two specific codes to report:   

57155 insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy

58346 insertion of Heyman capsules for clinical brachytherapy.

The descriptor for 77300 includes a small addition to include nonionizing radiation (new text is in bold type):

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.

Chemotherapy Administration

Chemotherapy administration code 96450 now specifies "spinal puncture" instead of "lumbar puncture."

96450 chemotherapy administration, into CNS [central nervous system] (e.g., intrathecal), requiring and including spinal puncture.

The descriptors for care plan oversight (CPO) services (99374-99379) have been revised to clarify whom the physician may coordinate care with:

99374 physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (e.g., Alzheimer's facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with healthcare professional(s), family member(s), surrogate decision maker(s), (e.g., legal guardian and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes.

The codes for hospice and nursing-facility patients (99377-99379) have been similarly revised. The requirements to bill for CPO, however, are not expected to change, and physicians must continue to adhere to a list of requirements:
 

The physician who bills CPO must be the same physician who signed the home health or hospice plan of care.
 

The physician must furnish at least 30 minutes of CPO within the calendar month for which payment is claimed and no other physician has been paid for CPO within that calendar month.
 

The physician must provide a covered physician service that requires a face-to-face encounter with the beneficiary within the six months immediately preceding the provision of the first CPO (a face-to-face encounter does not include EKG, lab services or surgery).