Oncology & Hematology Coding Alert

Question: What's the word on whether the 2006 demonstration project will continue?

Iowa Subscriber

Answer: CMS did not continue the paid demonstration project into 2007. A few of the 2006 demonstration project codes made it through to 2007, but reporting them is voluntary and won't be reimbursed.

The 2007 physician fee schedule gives G9050-G9055 (primary focus of the visit) and G9056-G9062 (guideline adherence) the status indicator -I,- meaning they are invalid and your contractor won't reimburse those codes.

Disease status codes G9076, G9081, G9082, G9118-G9122, and G9127 have been deleted.

As of press time, CMS won't reimburse you for the disease status codes from G9063-G9139 that remain active (www.cms.hhs.gov/PVRP/Downloads/PVRPCancerDemoCodes.pdf).

CMS states that these codes are available -pending finalization of quality measures directly applicable to cancer care- (www.cms.hhs.gov/PVRP/).

The finalized codes may be reimbursable under the Physician Voluntary Reporting Program that will start in July. Stay tuned for updates.

Resources: MLN Matters explains this change at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5459.pdf. You can also read more at www.cms.hhs.gov/Transmittals/downloads/R1143CP.pdf.