Oncology & Hematology Coding Alert

CMS is busy making changes that affect your reimbursement. Here's what you need to know.

CMS took a close look at the narrative describing conditions that make human chorionic gonadotropin (hCG) testing reasonable and necessary and decided 158.9 (Malignant neoplasm of retroperitoneum and peritoneum; peritoneum, unspecified) deserves to be on the covered codes list.

Physicians use hCG testing to monitor and diagnose germ cell neoplasia (www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=200).

CMS proposed a new version of the ABN form in the Feb. 23 Federal Register. The new form includes information about the beneficiary's right to demand that the provider bill Medicare for a service before paying out-of-pocket. And it now lets the patient choose among three options, instead of just two:

1. Don't provide the service

2. Provide the service and let the patient pay out-of-pocket

3. Provide the service and bill Medicare first.

Clarification: Patients have always had the right to insist that you bill Medicare and receive a denial before billing them out-of-pocket, but the form didn't make this clear before, says Joan Adler with Adler Advisory Services in Atlanta.