Oncology & Hematology Coding Alert

Descriptors for new codes alter your claims and could hurt your bottom line.

CPT 2009 only includes a few changes for radiation oncology coding, but they can make a big difference in how you report brachytherapy -- and what your physician will take to the bank. Check out the differences between four deleted codes

and their replacements to ensure you group treatments correctly and prepare for new reimbursement.

Previous editions of CPT listed four codes for remote afterloading high intensity brachytherapy, and you selected the code based on source positions or catheters:

- 77781 -- Remote afterloading high intensity brachytherapy; 1-4 source positions or catheters

- 77782 -- - 5-8 source positions or catheters

- 77783 -- - 9-12 source positions or catheters

- 77784 -- - over 12 source positions or catheters.

CPT 2009, however, deletes 77781-77784 and introduces three new codes for the same service:

- 77785 - Remote afterloading high dose rate radionuclide brachytherapy; 1 channel

- 77786 -- - 2-12 channels

- 77787 -- - over 12 channels.

Although the old codes referred to "high intensity brachytherapy" and the new codes apply to "high dose rate radionuclide brachytherapy," there's no difference between the terms, says Cindy Parman, CPC, CPC-H, RCC, principal and

co-founder of Coding Strategies Inc., a medical auditing and education firm in Powder Springs, Ga. The new codes with updated terminology help keep CPT on par with technology changes, she says.

Changing from descriptors based on "source positions or catheters" to "channels" will make a difference in how you report procedures, however -- and will affect your bottom line.

"They-re different pieces of the same puzzle," explains Clair Callaway, CPC, operations manager for RadMax Ltd., a radiation oncology billing and consulting firm in Tyler, Texas. "The radioactive source goes through channels into catheters

and is delivered to the patient, then removed."  Basing claims on channels will make a big difference to physicians in freestanding facilities, Callaway predicts. "The physician will always use one source and one channel for some cases, such as

MammoSite (or breast balloon brachytherapy). But HDR for uterine cancer and some others will take a hit."

The bottom line: It wouldn't be uncommon for the radiation oncologist to use 12 source positions and up to three channels for an HDR uterine procedure, Callaway says. Under CPT 2008, you would report 77783 with a national global

reimbursement of $1027.97.  Under CPT 2009 guidelines, if three channels are used, you report 77786 instead and get reimbursed about $470 less.

CPT 2009 includes a new section with two codes for spinal stereotactic radiosurgery and five new codes for cranial stereotactic radiosurgery:

- 63620 -- Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion

- +63621 -- - each additional spinal lesion (List separately in addition to code for primary procedure)

- 61796 -- Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator) 1 simple cranial lesion

- +61797-- - each additional cranial lesion, simple (List separately in addition to code for primary procedure)

- 61798  - 1 complex cranial lesion

- +61799 -- - each additional cranial lesion, complex (List separately in addition to code for primary procedure)

- +61800 -- Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure).

According to CPT guidelines, a "simple" cranial lesion is less than 3.5 cm in maximum dimension. Any lesion 3.5 cm in maximum dimension or larger is considered "complex." In addition, a lesion is classified as complex if it is adjacent

(5mm or less) to the optic nerve, optic chiasm, or optic tract or if the lesion is within the brainstem.

What you-ll do: The new stereotactic radiosurgery codes are for neurosurgeons, but you still need to be aware of them so you recognize the codes the neurosurgeon reports when he teams up with your oncologist.

For your own claims, you-ll still rely on the "Radiation Oncology" section (77261-77790) to report your radiation oncologist's services (clinical treatment planning, physics and dosimetry, treatment delivery, and management).