Oncology & Hematology Coding Alert

Learn the answer to whether an ICD-9 update freeze will go through.

Here's the scoop on two recent CMS releases that could affect your practice.

1. Get Up to Speed on Latest CCI Edits

The most recent version of the Correct Coding Initiative (CCI) edits for physicians went into effect Oct. 1, 2010. There are two revisions radiation oncology practices should watch for:

First, CCI changed the modifier indicator from 0 (never override edit) to 1 (possible to override edit with modifier) for the edit bundling the following codes:

• Column 1: 77290 -- Therapeutic radiology simulationaided field setting; complex
• Column 2: 77280 -- ... simple.

Second, you'll want to be sure to check your edits before reporting an E/M service with a radiation treatment delivery code, whether external or brachytherapy. CCI adds a long list of bundles for these codes. The good news is that you're unlikely to be reporting radiation delivery with most of the bundled E/M codes, which are in ranges covering nursing facility, rest home, and newborn care, for example.

Although most of the edits have a modifier indicator of 0, meaning you may not override the edit, edits bundling observation codes 99234-99236 into the delivery codes have a modifier indicator of 1, so you may override the edit with a modifier when appropriate.

Resource: You can access the latest physician edits from www.cms.gov/NationalCorrectCodInitEd/.

2. Expect ICD-9 Code-Set Freeze Next Year

2011 will be the last time ICD-9 will undergo a large overhaul.

CMS has followed through on its proposal to update the ICD-9 code set one last time on Oct. 1, 2011, after which no ICD-9 codes will be added to the set except for those updates required for new technologies and diseases.

That's the word from the ICD-9-CM Coordination and Maintenance Committee meeting, held on Sept. 15 and 16, where CMS's Pat Brooks explained the following process for ICD-9 and ICD-10 code updates:

Oct 1, 2011: The last regular annual updates will be made to the ICD-9 and ICD-10 code sets.

Oct 1, 2012: Limited code updates to the ICD-9 and ICD-10 code sets to capture new technologies and diseases.

Oct. 1, 2013: Limited code updates to ICD-10 code set to capture new technologies and diagnoses; ICD-9 will no longer be used for reporting purposes, so no updates to ICD-9 will take place.

Oct. 1, 2014: Regular updates to ICD-10 will begin.

Vendors, payers, and coding educators asked CMS to freeze the current diagnosis code set to help make ICD-10 transition planning simpler, so the announcement that CMS has confirmed a code-set freeze should assist you when you're trying to get the hang of ICD-10 coding.

To read the entire handout from the ICD-9-CM Coordination and Maintenance Committee meeting, visit www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp and click on "Sept. 15-16, 2010 Meeting Documents."