Oncology & Hematology Coding Alert

How did you do? Find out below.

 1. Procedure status: Status A means -Active code.- Medicare will separately pay covered status A codes.
 
You-ll see relative value units (RVUs) for these codes, but individual carriers/contractors decide coverage if there's no national coverage determination for the service.
 
You can find the status indicator listed with the other payment indicators (for example, in the searchable physician fee schedule at www.cms.hhs.gov/apps/pfslookup/).

 2. IMRT: A. Report one unit of 77301 (Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) per treatment course even when treating multiple targets in the same anatomic site, says Karen Beard, CPC, CHCC, Georgia Society of Clinical Oncology director and senior associate with Medical Management Associates.
 
Protect yourself: IMRT, which allows physicians to deliver high-dose radiation to some parts of a tumor while delivering lower-dose radiation to areas near sensitive tissues, is an emerging technology, so check your payer policies for frequent updates, Beard says.
 
 3. Diagnosis coding: D. A note with 182.8 (Malignant neoplasm of body of uterus; other specified sites of body of uterus) tells you the code is appropriate for -malignant neoplasm of contiguous or overlapping sites of body of uterus whose point of origin cannot be determined.-
 
Potential pitfall: The cervix is part of the uterus, says coding consultant Melanie Witt, RN, CPC-OGS, MA, in her audioconference, -Tackle Tough Gynecological-Oncology Coding,- for The Coding Institute.
 
But diagnosis codes differ based on whether the neoplasm is in the cervix or in the uterine body, so a cervical cancer code, such as 180.8 (Malignant neoplasm of cervix uteri; other specified sites of cervix), is incorrect for a uterine body neoplasm.
 
Note: Option C, three-digit code 182 (Malignant neoplasm of body of uterus) is not an appropriate answer because it requires a fourth digit for payers to consider it complete.
 
Three-digit code 179 (Malignant neoplasm of uterus, part unspecified) is a complete code, meaning that it does not require any additional digits, but it is not the best choice for the documented diagnosis.

4. HCPCS: False. The correct answer is 6 units of J0594 (Injection, busulfan, 1 mg).
 
Reason: HCPCS 2007 deleted C1178 (Injection, busulfan, per 6 mg), and an instruction with that code directs you to J0594.
 
The C codes include items, such as drugs, that  OPPS hospitals must use and that only report technical/facility services.
 
Pay attention: If you were accustomed to calculating busulfan units using the 6 mg in C1178, you need to adjust to the 1 mg in J0594.

5. Modifier 25: Report 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) alone for this encounter. You shouldn't bill a separate E/M when the patient comes in specifically for a laryngoscopy and the physician only takes the patient's vital stats but doesn't perform a full and separate E/M.
 
Don't miss: If a patient presents for a completely separate problem and after the oncologist provides the E/M service he decides a laryngoscopy is necessary, you can bill for both the E/M (with modifier 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and 31575 as long as the physician's documentation clearly explains the distinct reason for the laryngoscopy.
 
Smart: The physician should provide a separate procedure note for the laryngoscopy so you have
documentation that both services are separate and distinct. The separate procedure note does not have to be a separate piece of paper but should be at least a separate paragraph, rather than being buried in the examination portion of the E/M service.
 
Why it's a good idea: To recoup more reimbursement, many practices report an E/M code with modifier 25 for patients who visit for any checkup or procedure, regardless of whether their situation really justifies modifier 25, says John F. Bishop, PA-C, CPC, president and CEO of Bishop and Associates in Tampa, Fla. As a result, OIG and private payers have been cracking down on excessive 25 use.