Oncology & Hematology Coding Alert

Chemotherapy and radiation oncology CPT codes remain largely as they did in the 2000 edition. Codes for care plan oversight (CPO) for home health (99374-99375) and hospice (99377-99378) will be replaced by temporary codes added to HCPCS 2001, and a new code for the collection of blood from an implantable pump or port (36540) will also be added.

Most of the oncology-related changes will clarify code usage and make it more understandable to physicians. The changes reflect language that more closely match the way physicians practice medicine, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies, a coding consulting firm based in Dallas, Ga.

Definition Revised for 77470

One of the changes includes revised language to 77470 (special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, vaginal cone irradiation]). The new version defines 77470 as special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation). Endocavitary or intraoperative cone irradiation replaces the term vaginal cone irradiation. The revision reflects a definition more closely resembling language used by radiation oncologists in describing and planning treatment, Parman says.

The revised language, however, does not affect how physicians determine the level of radiation treatment management. For example, in addition to daily or weekly patient management, 77470 still requires that the procedure be performed one or more times during therapy.

Care Plan Oversight Changes

Further changes set for 2001 affect CPO, now 99374 and 99375 for home health, and 99377 and 99378 for hospice. The Health Care Financing Administration (HCFA) has released two new CPO codes to replace those found in CPT 2000. Physicians will have to bill CPO using the 2001 HCPCS code G0181 and G0182, new temporary codes. G0181 will apply to home health patients, and G0182 will apply to hospice patients.

While the codes have changed, the requirements related to using them have not, says Nancy Cothern, business manager at Baptist Cancer Institute in Jacksonville, Fla. For example, Palmetto Government Benefits Administrator, a Medicare payer, offers the following directives to its Medicare providers when using these new codes:

The beneficiary must require complex or multidisciplinary care modalities requiring ongoing physician involvement in the patients care plan.

The beneficiary must receive Medicare-covered home health agency (HHA), hospice or nursing facility services during the period in which the CPO services are furnished.

The physician billing CPO must be the same physician who signed the home health or hospice care plan.

The physician must furnish at least 30 minutes of CPO within the calendar month for which payment is claimed and no other physician has been paid within that calendar month.

The physician must provide a covered physician service that requires a face-to-face encounter with the beneficiary within the six months immediately preceding the provision of the first CPO service.

The CPO billed must not be routine postoperative care provided in the global surgical period of a procedure billed by the physician.

For beneficiaries receiving Medicare-covered home health services, the physician must not have a significant financial or contractual interest in the home health agency.

For beneficiaries receiving Medicare-covered hospice services, the physician must not be the medical director or an employee of the hospice or providing services under arrangements with the hospice.

CPO services must be personally furnished by the physician who bills them.

Services provided incident-to a physicians service do not qualify as CPO and do not count toward the 30-minute requirement.

The physician may not bill CPO during the same calendar month that he or she bills the Medicare monthly capitation payment for the same beneficiary.

The physician billing for CPO must document in the patients record which services were furnished and include the date and length of time.

In addition to the numerous rules associated with CPO codes, tracking the length of each phone call for overseeing patient care can be tedious. Physicians should document the length of time to choose the appropriate time-based code (G0181 and G0182). If you dont track your calls, you wont get paid, Cothern says.

Cothern recommends oncology practices implement a log system to routinely track the length of time a physician spends on the phone reviewing home health or hospice patient care.

New Recertification Codes

In addition to new CPO codes, oncology physicians who refer their patients to home care will have an opportunity to bill Medicare for home-care-related work. HCFA also established a new code set for certifying and recertifying home health plans of care.

HCFA officials say the new payment was added to encourage greater physician involvement. Code G0179 will be used to recertify a patient who has received home health services for at least 60 days, or one certification period. Code G0180 applies to patients who have not received Medicare-covered home health services for at least 60 days. Oncologists will earn about $61 for each certification and $53 for each recertification. The two amounts are based on national averages. Amounts adjusted for region and other factors will not be available until the final physician fee schedule is released.

New Code for Blood Collection

In the past, it has been assumed that collecting blood specimens prior to or after chemotherapy was included as part of chemotherapy administration reimbursement. The new code, 36540 (collection of blood specimen from a partially or completely implantable venous access device), leaves open the possibility that payers will unbundle this common procedure from chemotherapy administration.

In a notation under 96530, CPT 2001 directs oncology practices to use 36540 (refilling and maintenance of implantable pump or reservoir). Parman warns that the presence of a new code for blood specimen collection does not guarantee Medicare and others will pay for the procedure separate of chemotherapy administration.