Oncology & Hematology Coding Alert

Coding changes for radiation oncology top the list of new codes and revisions included in the recently released CPT 2000. The change represents a theme to reduce the amount of subjective choices coders must make and allow them to assign a code based on more specific criteria, experts say.

CPT 2000 is very specific and easier to use, says Dianne Willard, RHIA, CCS-P, director of coding products and services for the American Health Information Management Association (AHIMA).

One Code Replaces Four

The new CPT manual includes changes in radiation oncology that simplify the way treatment management is coded. New code 77427 (radiation treatment management, five treatments) replaces CPT 1999 codes 77419, 77420, 77425 and 77430 under clinical treatment management. The deleted codes represented various complexity levels of treatment management.

Because the differences in levels were distinguished by technical nuances and did not necessarily reflect differences in time and effort, the code was simplified, experts say.

For example, discussion of weekly radiation management could be confusing, Willard says. What is the definition of weekly? What if there were only three sessions in a week or one in four weeks? Its much more specific now.

But while coders may find 77427 simpler to use, some are uncertain how it will affect an oncologists bottom line reimbursement. Several radiation oncology treatment management practices fell under codes designated for complex situations that required three or more separate areas to be treated.

Because of the greater complexity, a higher relative value unit (RVU) was assigned to the higher-level codes compared to simple treatment management. With the CPT 2000 consolidation of the treatment management codes, there is concern that the new code, coupled with a smaller RVU, will result in less payment for all treatment management claims, says Cindy Parman, CPC, CPC-H, principal, CSI Consulting, a Dallas, GA-based medical coding consulting firm that includes radiation oncology practices.

The new CPT 2000 code for radiation treatment management also includes revised language to better explain the single codes use. According to the new manual: Radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days. Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy sessions and the fractions are of the character usually furnished on different days.

When fractions are not in units of five, the manual states that this code (77427) should be reported if there are three or four fractions beyond a multiple of five at the end of the course of treatment. One or two fractions beyond a multiple of five should not be reported separately.

Professional services furnished during treatment management typically include:

- Review of port films;

- Review of dosimetry, dose delivery and treatment parameters;

- Review of patient treatment set-up; and

- Examination of patient for medical evaluation and
management.

Although the codes for these services have been consolidated into one for 2000, the documentation for treatment management does not change, Parman advises. Doctors still need to document weekly progress notes, she adds. Aside from the obvious name and date, they need to summarize their treatment orders, including port films, patient levels and medication status. All of these procedures still have to take place.

New Category Instituted

The only other CPT 2000 change in radiation oncology calls for the creation of a new category: Proton beam treatment and delivery.

Codes 77380 and 77381, new codes in 1999 that were
used to show use of proton beam delivery, have been deleted. For 2000, proton treatment delivery has two new codes, CPT 77520 and 77523.

The 1999 codes were listed under medical radiation
physics, dosimetry, treatment devices, and special services. The new codes are listed under proton beam treatment delivery. Code 77520 should be used for delivery to a single treatment area, custom block, or port, and with or without compensation. And 77523 should be used for delivery to one or two treatment areas, two or more custom blocks or ports, and with two or more compensators.

Last year the codes were listed in medication radiation physics, and they really didnt belong there, Parman says. Now its in a category of its own, which is better.