Oncology & Hematology Coding Alert

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Now when your radiation oncologist performs stereotactic radiosurgery, you will not have to bundle treatment devices used on the same day into the procedure, thanks to the National Correct Coding Initiative (NCCI), version 9.2, which took effect July 1.

NCCI deleted the bundling of G0242 (Multi-source photon stereotactic radiosurgery [cobalt 60 multi-source converging beams] plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment) with 77332 (Treatment devices, design and construction; simple [simple block, simple bolus]), 77333 (... intermediate [multiple blocks, stents, bite blocks, special bolus]) and 77334 (... complex [irregular blocks, special shields, compensators, wedges, molds or casts]).

CMS unbundling of G0242 and 77332-77334 could provide you with a new source of revenue. For instance, your radiation oncologist treats a brain tumor (191.x) with a stereotactic radiosurgery (SRS) plan. Previously, Medicare would pay you only for G0242. Now, you could bill 77334 for the construction of treatment devices and blocks that your physician develops to implement the SRS plan on the same day. For 77334, CMS could reimburse you about $187, if your physician owns the equipment and performed the procedure in an office setting.

Remember that you cannot report 77332-77334 for prefabricated blocks or devices, only for those blocks or devices that your oncologist had to customize for the patient.

In other news, keep your eye on another form of stereotractic radiosurgery (G0251, Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment), which CMS has bundled into a number of codes.

NCCI bundled comprehensive code G0251 with 20660 (Application of cranial tongs, caliper or stereotactic frame ...]), +61795 (Stereotactic computer assisted volumetric [navigational] procedure ...]), +69990 (Microsurgical techniques, requiring use of operating microscope ...), 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation ...), 77401-77416 (Radiation treatment delivery) and 77432 (Stereotactic radiation treatment management of cerebral lesion[s] [complete course of treatment consisting of one session]). These are mutually exclusive codes, meaning that under no circumstances can you unbundle the procedures with modifier -59 (Distinct procedural service).

NCCI bundled G0251 into these nonmutually exclusive codes: 77280-77295 (Therapeutic radiology), 77305-77315 (Teletherapy), 77321 (Special teletherapy port plan, particles, hemibody, total body), 77326-77328 (Brachytherapy isodose plan), 77332-77334 (Treatment devices), 77336 (Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy) and 77370 (Special medical radiation physics consultation).

Under the appropriate circumstances, you may use modifier -59 to unbundle these codes when performed on the same day. For example, your radiation oncologist plans to treat a Medicare patients neck cancer (195.0) with stereotactic radiosurgery (G0251) after other radiation treatment plans, such as 77427 (Radiation treatment management, five treatments), have failed. Prior to your oncologists administering G0251, however, your freestanding clinics physicist consults with the patient regarding the past radiation treatments. If you bill for the consultation on the same day of the stereotactic radiosurgery, report 77336-59.