Oncology & Hematology Coding Alert

Hint: If it's a new code for -09, it probably has an edit.

CPT 2009 overhauled your coding choices for brachytherapy, hydration, and some of your most common injections and infusions. Now the Correct Coding Initiative (CCI) follows suit, with hundreds of oncology-related edits going into effect with CCI 15.0 for claims filed Jan. 1-March 31, 2009.

Virtually every edition of CCI includes some deletions along with all the additions, but the list is usually short. With CCI 15.0, however, the total number of deletions almost equals the additions. The extensive deletions aren't necessarily unusual, says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga. "We have many deletions every time we change codes," she says. "The infusion codes have especially changed often during the last three years or so."

Fortunately, the deletions are easy to track -- they all involve codes that CPT deleted for 2009.

Many were previously paired with brachytherapy procedures such as 77750 (Infusion or instillation of radioelement solution [includes 3-month follow-up care]) or 7777x (Interstitial radiation source application ...). Some of the now-defunct edits that oncology coders will need to note include codes 90760, 90765, 90772, 90774, and 90775 for hydration and infusions.

CPT 2009 recast the codes for hydration and therapeutic, prophylactic, and diagnostic injections and infusions. All of the 9076x and 9077x codes moved from the "Vaccines, Toxoids" section to new sections adjacent to the chemotherapy codes. That means any edits previously associated with 9076x or 9077x are no longer in effect.

As could be expected, however, edit additions balance out most of the oncology-related deletions.

The bulk of mutually exclusive edits focus on three new brachytherapy codes:

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

- 77786 -- - 2-12 channels

- 77787 - - over 12 channels.

CCI 15.0 lists these new brachytherapy codes as mutually exclusive with many radiology procedures, including:

- 77776-77778 -- Interstitial radiation source application

- 78000-78018 -- Thyroid uptake, thyroid imaging, or thyroid imaging with uptake

- 78070 -- Parathyroid imaging

- 78075 -- Adrenal imaging, cortex and/or medulla

- 78300-78320 -- Bone and/or joint imaging

- 79200, 79300, and 79440 -- Radiopharmaceutical therapy.

The vast majority of diagnostic tests for certain body systems are also considered to be mutually exclusive with the new brachytherapy codes. These include diagnostic tests for the hematopoietic, reticuloendothelial, and lymphatic system (78102-78195), gastrointestinal system (78201-78291), cardiovascular system (78414-78483), respiratory system (78580-78596), nervous system (78600-78660), genitourinary system(78700-78761), and other diagnostic radiology procedures (78800-78807).

Pinpoint specifics: A few exceptions apply in each of these categories, so check CCI 15.0 edits for the full picture.

Though the list is long and you need to be aware of them, the edits might not apply to an oncology coder's day-to-day life.

"These services are primarily for nuclear medicine and aren't normally performed on the same day as brachytherapy, anyway," Parman says. "If they-re performed at all, they probably wouldn't be performed by a radiation oncologist."

Easy chemo edit: After contending with all of those brachytherapy edits, it's nice to know only one of the new infusion codes is included with mutually exclusive edits. You cannot bill for 96369 (Subcutaneous infusion for therapy or prophylaxis [specify substance or drug]; initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site[s]) during the same session as procedures 96405 (Chemotherapy administration; intralesional, up to and including 7 lesions) and 96406 (- intralesional, more than 7 lesions).

You-ll find new CPT codes 77785-77787 and 96360-96368 prominently listed among the non-mutually exclusive edits as well. Each is considered a component of clinical brachytherapy codes 77750-77778.

Flip side: New brachytherapy codes 77785-77787 are the comprehensive procedure of some other non-mutually exclusive edit pairs, however. Procedures considered part of 77785-77787 include:

- 0182T -- High dose rate electronic brachytherapy, per fraction. CPT lists a number of radiology codes you cannot report with 0182T, but 77785-77787 are not part of that list. Be sure to note the addition in your CPT book to prevent miscoding.

- 36000 -- Introduction of needle or intracatheter, vein

- 36410 and 36425 -- Venipuncture

- 51701-51703 -- Insertion of non-indwelling or temporary bladder catheter

- 76873 -- Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

- 77790 -- Supervision, handling, loading of radiation source.

CCI 15.0 edits also lists two moderate sedation services as components of 77785-77787. Do not report 99143 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time) or 99144 (- age 5 years or older, first 30 minutes intra-service time) with the new brachytherapy codes. Also remember that 99143 and 99144 are modifier 51 (Multiple procedures) exempt, which reinforces the edit.

Injection and infusion inclusion: Non mutually-exclusive edits also apply to the new injection and infusion codes 96365-96379. Each is listed as a component of chemotherapy procedures such as 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic) and 96420 (Chemotherapy administration, intra-arterial; push technique).

Check the lists: CCI 15.0 has such extensive lists of edits that we can't include everything here. For a complete list of edits and their usage modifiers, log on to www.cms.hhs.gov.