Oncology & Hematology Coding Alert

CMS uses the latest round of edits to do some spring cleaning.

The Correct Coding Initiatives latest release is enough to make you want to kiss your CCI software -- unless you enjoy manually scrolling through 300,000 lines of codes to see whats new. The good news is the latest edits shouldnt hit your pocketbook (the 63620 edits arent as bad as they seem) and should help keep your claims on track. Heres what you need to know.

Find the Oncology Codes Among the Masses

Although CCI created a huge list of new edits this round, there are only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, according to Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in his March 25, 2009, webinar NCCI Version 15.1 Update.

A large proportion of the edits bundle the typical injections and other procedures performed during surgery in the main surgical procedure or service, so they shouldnt affect your day-to-day oncology coding if youve been coding correctly all along.

For example: If you code procedures such as 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy), be sure youre aware of the following.

Some of the edits have a modifier indicator of 1, meaning you may override the edit with a modifier when appropriate (such as when the services are at different anatomic sites or at separate encounters).

The following column 2 codes are among those bundled into 55875 and similar procedures with a 1 indicator:

" Venipuncture: 36400-36406, 36420-36425

" Transfusion: 36430-36440

" Arterial puncture/catheterization: 36600, 36640

" Anesthetic agent injection: 64505-64530

" Surface neurostimulator application: 64550

" ECG: 93000-93010, 93040-93042

" Transesophageal echocardiography: 93318

" Pulmonary services: 94002, 94200, 94250, 94680-94690, 94770

" Electroencephalography: 95812-95822, 95829, 95955

" Sequential IV push: +96376.

Other edits have a modifier indicator of 0, which means you may never override the edit, Cohen explains.

In particular, the following column 2 codes are bundled into 55875 with a 0 indicator:

" Epidural or subarachnoid injection: 62310-62311

" Anesthetic agent injection: 64400-64413, 64418-64449, 64479, 64483.

Best bet: Before reporting any of the above listed column 2 codes, check your coding edits. CCI 15.1 also bundles most of these same codes into 96405-96406 (Chemotherapy administration; intralesional &), 96440 (Chemotherapy administration into pleural cavity &),96445 (Chemotherapy administration into peritoneal cavity &), 96450 (Chemotherapy administration, into CNS &), 77750-77778 and 77789 (brachytherapy), and 36511-36516 (therapeutic apheresis).

SRS and 77xxx Dont Belong on Same Claim

CCI also creates some new edits specific to particular services. For instance, note that new code 63620 (Stereotactic radiosurgery [particle bam, gamma ray, or linear accelerator]; 1 spinal lesion) has a number of column 1/column 2 edits with a modifier indicator of 0, which means you may never override them. The following codes are bundled into 63620:

" Radiation treatment planning and simulation codes 77261-77295

" Intensity modulated radiotherapy plan code 77301

" Special teletherapy port plan code 77321

" Special dosimetry code 77331

" Medical physics consultation codes 77336, 77370

" Radiation treatment delivery codes 77401-77417.

Remember the rule: NCCI edits have been developed for application to Medicare services billed by a single provider for a single patient on the same date of service, according to the introduction to the NCCI Policy Manual for Medicare Services.

Application: You may still report your radiation oncologists 77xxx services for a stereotactic radiosurgery patient when the neurosurgeon performs and reports 63620 on his own claim.

Tackle Transfusion Medicine Edits

If you have a lab and code for the indirect Coombs test used to find antibodies in blood before a transfusion, watch your coding.

CCI creates a mutually exclusive edit with 86885 (Antihuman globulin tests [Coombs test]; indirect, qualitative,each reagent red cell) in the column 1 position and 86850 (Antibody screen, RBC, each serum technique) in the column 2 position. Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same patient encounter, states Chapter 1 of the NCCI Policy Manual (www.cms.hhs.gov/NationalCorrectCodInitEd/).

These two codes basically describe the same test,says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Watch for: A note under the 86880-86886 series in the CPT manual states that you should report 86850 for indirect antihuman globulin (Coombs) test for RBC antibody screening, acknowledging that 86850 also describes an indirect Coombs test.

Resource: CCI version 15.1 took effect April 1. You can access the edits online at www.cms.hhs.gov/NationalCorrectCodInitEd/.