Oncology & Hematology Coding Alert

Hold on to your coding caps -- Correct Coding Initiative version 14.1 brings some great changes with it that are sure to help make radiosurgery reimbursement a snap.

Effective April 1, CCI deletes the edits bundling basic dosimetry calculations code 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) with these radiosurgery treatment delivery codes:

"If 77300 and 77334 (Treatment devices, design and construction; complex [irregular blocks, special shields, compensators, wedges, molds or casts]) are now unbundled from radiosurgery (77371-77373), this is great," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

"Prior to this change, the basic calculations were listed with a modifier indicator of 1," Parman says.

As a rule, modifier indicator 1 means that you can override the edit with modifier 59 (Distinct procedural service) in appropriate circumstances, says Vicky Varley O-Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis, Mo., in The Coding Institute audioconference "Modifiers 25 and 59 Best Practices That Keep Your Claims in the Clear"(http://www.audioeducator.com).

For this particular edit, you could report the codes "separately with a modifier only when the calculations were performed for a separate anatomic site than the tumor volume receiving radiosurgery," Parman says.

This change in the bundling edit allows you "to report the dosimetry calculations in addition to the radiosurgery plan and treatment devices, at a frequency of one unit per gantry angle, shot, path or arc depending on the type of equipment used for treatment," Parman says.

Payoff: Being able to report 77334 with these codes will bring in about $177 (4.65 transitioned facility relative value units [RVUs] multiplied by the conversion factor, 38.087). And 77300, with 2.08 RVUs, brings in about $79.

Where to go next: You can download more information on the CCI 14.1 edits at the CMS Web site http://www.cms.hhs.gov/NationalCorrectCodInitEd/.