Oncology & Hematology Coding Alert

Radiopharmaceutical Therapy Family Getting 2005 Facelift

Published on Mon Nov 15, 2004

Experts predict easier reporting after transition period

When your oncologist performs radiopharmaceutical gland ablation on a thyroid carcinoma patient in 2005, it looks as if CPT will want you to code the procedure with a new oral administration code. In fact, the oral administration code is set to stand in for several old codes that CPT has deleted in next year's edition.

You'll soon have three new radiopharmaceutical therapy codes that specify administration method - which could make your claims for these services easier to file. Starting Jan. 1, you can use these new nuclear medicine codes:

79005 - Radiopharmaceutical therapy, by oral administration

79101 - Radiopharmaceutical therapy, by intravenous administration

79445 - Radiopharmaceutical therapy, by intra-arterial particulate administration.

CPT 2005 also includes other changes that alter the 79000-79999 nuclear medicine code family considerably, cutting away a cache of old codes to make way for these three new ones and revising descriptions for four other codes.

Changes for the Better in the Long Run

The bottom line: Though there will be growing pains, coders will probably be better off with the new codes once they get used to using them.

"The nuclear medicine code [family has] been condensed, and reports method of administration rather than body area," says Cindy Parman, CPC, CPC-H, RCC, president elect of the AAPC National Advisory Board and president of Coding Strategies Inc. in Dallas, Ga.

"Regarding scenarios (in which coders would use these codes), we can only guess at this point, but it seems coding will be simplified in this section" in 2005, Parman says.

Note: Oncology offices need to acknowledge these relevant changes in radiopharmaceutical therapy codes before Jan. 1, 2005, when CMS mandates that you use the new codes. Remember, there is no 90-day grace period to get used to the new code additions and deletions.

Intracavitary Administration Code Has New Descriptor

In addition, CPT will also update the descriptions of these four codes, which will read as follows beginning on Jan. 1, 2005:

79200 - Radiopharmaceutical therapy, by intracavitary administration

79300 - Radiopharmaceutical therapy, by interstitial radioactive colloid administration

79440 - Radiopharmaceutical therapy, by intra-articular administration

79999 - Radiopharmaceutical therapy, unlisted procedure.

Thyroid Suppression Reported Differently in 2005

While the nuclear medicine code group gained several new codes, CPT deleted the following codes from the family in 2005:

79000 - Radiopharmaceutical therapy, hyper-thyroidism; initial, including evaluation of patient

79001 - ... subsequent, each therapy

79020 - Radiopharmaceutical therapy, thyroid suppression (euthyroid cardiac disease), including evaluation of patient

79030 - Radiopharmaceutical ablation of gland for thyroid carcinoma

79035 - Radiopharmaceutical therapy for metastases of thyroid carcinoma

79100 - Radiopharmaceutical therapy, poly-cythemia vera, chronic leukemia, each treatment by intravenous injection

79400 - Radiopharmaceutical therapy, nonthyroid, nonhemotalogic by intravenous injection

79420 - Intravascular radiopharmaceutical therapy, particulate

79900 - Provision of therapeutic radiopharmaceutical(s).

Reminder: Note these deletions somewhere in your office so everyone knows what NOT to report next year.

79005 Could Replace 79030

How these additions and deletions will affect oncology offices is a tough call, experts say. Water-cooler talk about the new codes abounds, and The Cancer Center in Swansea, Ill., is no different, according to patient account representative Beth Potratz. The theory floating around her office contends that procedures previously reported with 79030 will be reported with 79005 in 2005.

Insider Confirms Several Code Bundles

"Actually, there is a parenthetical note in the 2005 CPT Manual that states: '79020, 79030, 79035 have been deleted. To report, use 79005,' " says an inside source who has had a peek at the new book.

In addition, the intravenous administration codes (79100, 79400) are probably going to be used for "the types of radiotherapies that do not have their own codes," Potratz says.

Note: Look for specific coding examples using the new CPT codes in future issues of Oncology Coding Alert.

PET Scan Codes or G Codes? Wait and See

Oncology practices with their own PET/CT scanners should take note of the following codes for 2005:

78811 - Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck)

78812 - Tumor imaging, positron emission tomography (PET); skull base to mid-thigh

78813 - Tumor imaging, positron emission tomography (PET); whole body

78814 - Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck)

78815 - Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh

78816 - Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body.

How should we use them? "Regarding the PET scan codes, coding will depend on whether CMS deletes some of the existing G codes in favor of the CPT codes. We won't know that until they publish their final rules for physician and hospital services," Parman says.

One thing's for sure, though. "The PET scan codes have to be used [by offices] with the PET/CT scanner, which is a special machine in itself," Potratz says.