Oncology & Hematology Coding Alert

Good news: Your Medicare carrier may pay about $60 for 78803-26 ([SPECT]; professional component). You should attach modifier -26 to represent the radiation oncologist's professional services. Typically, an oncologist reviews and interprets the results or image. Also, on July 1, Medicare increased 78804's RVUs to 11.14, which means you can expect about $428 per 78804-26 charge.

CMS Corrects 'Fast-Track' Error

NCCI deleted the 78804-78803 bundle because it implemented the edit on a "fast- track" basis, Merlino says. This means that professional societies, such as the Society of Nuclear Medicine, did not have an opportunity to comment prior to the edit.

"The code pair combination of whole body and SPECT for either bone imaging or tumor imaging has been a normal part of nuclear medicine imaging for many years," Merlino says. Physicians perform several types of whole-body tumor and SPECT studies, including monoclonal antibody imaging with agents, Bexxar or Zevalin, prostascint imaging, and gallium imaging for malignant disease, Merlino says.

For example: The radiation oncologist uses radiopharmaceutical localization to test radioimmunotherapy agents Zevalin and Bexxar. By using  the localization technique, the physician determines whether the radiopharmaceutical will target a patient's tumor or will concentrate in critical organs. For this service you could report 78804. Afterward, the physician performs a SPECT study to increase the specific anatomical localization and augmented lesion count density.

Best bet: Check your carrier's policy on how to submit 78804-78803 claims, because some insurers require modifier -51 (Multiple procedures). Therefore, when you report 78804 and 78803 to these carriers, make sure you attach modifier -51 to one of the codes, Merlino says.

Coders use this modifier when they report multiple procedures. If you assign -51, remember that payers reduce the code's payment by half. That means you should link the modifier to 78803, because this is the lower paying code.

NCCI Spares Weekly Treatment Management Codes

In other news, Medicare nixed a proposed edit that would have bundled radiation management codes (for example, 77427, Radiation treatment management, five treatments) with port films (77417, Therapeutic radiology  port film[s]). Radiation oncology societies, the American College of Radiology and the American Society for Therapeutic Radiology and Oncology, both requested that NCCI delete the proposal.

Here's why: Code 77417 represents the physician or staff's technical services, says Lori Stuart, a billing specialist and co-owner of Physician Management Services of Iowa in Atlantic.

You should report this code when the provider uses his  equipment to take the port films. The code carries no professional component. On the other hand, 77427 describes the oncologist's review and interpretation of the port films. Therefore, you should be able to report both codes separately.