Oncology & Hematology Coding Alert

Question: We recently added a CDSM module to our EHR to comply with CMS' new rule about appropriate use for imaging. Does it actually have to be a physician who goes into the software, or can support staff take care of this?

Louisiana Subscriber

Answer: Starting July 1, 2018, providers may use modifier QQ to show that they consulted Appropriate Use Criteria for advanced diagnostic imaging for Medicare patients (like CT, PET, or nuclear medicine).

Appending modifier QQ (Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional) is voluntary-for now. "We have a long ramp-up period, but it's going to go by in a heartbeat," says Cindy C. Parman, CPC, CPC-H, RCC, AHIMA Approved ICD-10-CM trainer and executive vice president of Coding Strategies, Inc.

Whoever is ordering the test is the clinician who needs to get on the software, advises Parman, who presented about 2018 coding updates at the Oncology Reimbursement Meeting of the Association of Community Cancer Centers in Richmond, Virginia. It is a decision tree and there are questions about the patient that must be answered.

"This is going to be a lot of work. Talk to your doctors because this is going to be physician time," Parman warns. The CDSM software may link into your EHR, but with some systems it will be an entirely separate program.

And what if you don't agree with the CDMS' recommendation? You can override it, but think twice, says Parman. CMS will identify individuals that consis­tently override the CDSM and they will be put on pre-authorization for those tests. This program is intended to save CMS $200 million over the next 10 years.