Oncology & Hematology Coding Alert

Don't worry -- 13.0 isn't too unlucky for oncology

National Correct Coding Initiative ( NCCI Edits ), version 13.0, effective Jan. 1 for physicians, takes aim at 2007's new codes. But the new edits should help you keep your claims clean rather than causing you new headaches. Here are the highlights.

- New stereotactic radiosurgery codes 77371-77373 and stereotactic body radiation therapy code 77435. CPT 2007 added these codes in place of G codes and Category III codes available in 2006. Reality: Hospitals reported the G codes, but payers didn't always accept them from freestanding centers. If coding these procedures is entirely new to you, take time to get a handle on the pages of bundling guidelines involved.
 
A large number of the edits for these codes won't allow a modifier to break the edit, including ones bundling tattooing codes 11920-11921, stereotactic volumetric procedure code 61795, and 33 E/M codes. 
 
Key: You also can't override the edit bundling stereoscopic x-ray guidance code 77421 into the stereotactic radiosurgery codes, which include imaging by definition.

- Guidance codes with new digits but not new descriptors. CPT 2007 changed the digits for codes such as 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]), which was 76003 in 2006, and 77014 (Computed tomography guidance for placement of radiation therapy fields), which was 76370 in 2006.
 
NCCI 13.0 creates edits for these new codes, reminding you that Medicare typically includes guidance in the procedure.

Example: NCCI 13.0 creates the following non-mutually exclusive edits. You should not report the column 2 code with its paired column 1 code. If you do, payers will only reimburse you for the column 1 code. The -0- modifier indicator tells you that you cannot use a modifier to break the edit.

Column 1      Column 2    Modifier Indicator

  77295           77014          0

  77301           77014          0

  77305           77014          0

  77310           77014          0

  77315           77014          0

Resource: You can find the edits on the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.