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. 
New IMRT Codes
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 [...]