Oncology & Hematology Coding Alert

Oncology coding is popping up all over the regulatory radar. Track the latest updates with this look at three pieces of news you can use.

You can probably recite consult coding's three R's in your sleep, but Medicare may decide those infamous requirements are on the way out. For 2010, CMS plans to end payment for consult codes, according to the proposed Medicare Physician Fee Schedule, printed in the July 13 Federal Register (http://edocket.access.gpo.gov/2009/E9-15835.htm).

Less hassle but less cash? Instead of reporting consult codes, you'd report new or established patient office visit or hospital care (E/M) codes for these services, and CMS would increase payments for the existing E/M codes.

To determine the impact of this change, you'd have to compare the reimbursement from the new fee schedule office visit fees vs. the current office consult fees, as well as the new hospital visit E/M charges vs. the current hospital consult fees, says Quinten A. Buechner, MS, MDiv, CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis. Using this year's figures, you'd lose between $16 to $45 for office consults that would now be coded as new patient visits, and you'd lose $30 to $100 for established office consults coded as E/Ms, Buechner says. A rough calculation shows that planned additional E/M payments may not cover the loss of consult money. Radiation oncologists may feel an additional pinch. The Correct Coding Initiative currently bundles both clinical treatment plans (77261-77263) and simulations (77280-77295) into new and established patient visits, and you can't override the edits. Consultations aren't bundled into clinical treatment plans and simulations, so you may report the E/M and the service on the same date.

More hits to the wallet: CMS is projecting a record 21.5 percent rate cut (proposed conversion factor is $28.3208), and the proposed rule (Table 39) indicates that you can expect practice expense and malpractice changes to drop hematology/oncology reimbursement 6 percent. Radiation oncology can expect a decrease closer to 20 percent. Table 40 reveals 77427 (Radiation treatment management, 5 treatments), for example, could see a 17 percent decrease. That means coding services correctly the first time is even more important to your practice's financial health.

Oncology and Hematology Coding Alert, Vol. 11, No. 8, covered the proposed ICD-9 code changes for 2010. Now the final list is out, so be sure you note the differences:

• Proposed: 209.75 -- Merkel cell carcinoma, unknown primary site

• Final: 209.75 -- Secondary Merkel cell carcinoma.

• Proposed: V10.90 -- Personal history of unspecified type of malignant neoplasm

• Final: V10.90 -- Personal history of unspecified malignant neoplasm. The final rule also added a revision:

• 2009: 453.2 -- Other venous embolism and thrombosis; of vena cava

• 2010: 453.2 -- Other venous embolism and thrombosis; of inferior vena cava.

"ICD-9 revised code 453.2 is for embolism and thrombosis of the inferior vena cava that one may see with extension of a renal cell carcinoma," for example, says Michael A. Ferragamo MD, FACS, clinical assistant professor at State University of New York, Stony Brook.

Resources: You can find the final list of codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp. And the addendum is available online at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm.

If the OIG had its way, you'd never have to spend another moment confused about whether to report a chemotherapy administration code (such as 96401-+96417) or a lesser-valued admin code (such as 96365-96379) for a particular drug.

Read all about it: In a recent report, the OIG says it set out to analyze Medicare payments for 2005-2007 Part B chemotherapy administration claims, but because providers don't always bill drugs to Part B, the OIG couldn't determine whether $60 million worth of unmatched claims were inaccurate.

Furthermore, the OIG found that without a national list of drugs that qualify for chemo admin codes, payer policies were inconsistent. CMS didn't agree with OIG's recommendation to create a national list, however, so you'll need to continue heeding your contractor's preferences.

You can find the report online at http://oig.hhs.gov/oei/reports/oei-09-08-00190.pdf .