Oncology & Hematology Coding Alert

Narrow your choices to only three codes for radiation treatment.

Effective Jan 1, 2015, you will see some new codes for vaccinations and chronic care management while having to take into account some descriptor changes to old codes. Mark these changes for the next year and learn how these impact your practice.

Observe Changes to Vaccination Codes

As happens each year, you will be seeing some changes to vaccination codes. In CPT® 2015, you will have to add two new vaccine codes to your practice while making note of many changes to the descriptors of old codes.

The two new codes include:

• 90630 (Influenza virus vaccine, quadrivalent [IIV4], split virus, preservative free, for intradermal use)
• 90651 (Human Papilloma virus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent [HPV], 3 dose schedule, for intramuscular use)

Are you looking for a new code for trivalent influenza vaccine in CPT® 2015? You will find none. CPT® has made some changes to code descriptors for trivalent influenza vaccine and some others too. The new code 90630 is for quadrivalent vaccine. This new vaccine will include 2 influenza B viruses instead of the one included in the trivalent vaccine. 

And of course, you still have the existing trivalent codes 90655-90658 (Influenza virus vaccine, trivalent, split virus …), 90660 (Influenza virus vaccine, trivalent, live, for intranasal use), and 90673 (Influenza virus vaccine, trivalent, derived from recombinant DNA [RIV3], hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use).  You will select your code based on the product administered.  Be sure the product is preservative free, the route is IM or intranasal, or if the product is both preservative and antibiotic free.

Don’t miss: CPT® introduced some revisions to some vaccine codes. You will be seeing the following descriptor changes in CPT® 2015:

• 90654 (Influenza virus vaccine, trivalent [IIV3], split virus, preservative-free, for intradermal use)
• 90721 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DtaP-Hib)[DTaP/Hib], for intramuscular use)
• 90723 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitishepatitis B, and inactivated poliovirus vaccine [DTaP-HepB-IPV], for intramuscular use)
• 90734 (Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 tetravalent, quadrivalent, for intramuscular use).

Note: The new codes, 90630 and 90651, carry the lightning bolt (~) sign that indicates that these codes are still awaiting FDA approval.

“The revisions to the existing codes are primarily editorial or otherwise made to distinguish the existing codes from new codes that will appear in 2015,” observes Kent Moore, senior strategist for physician payment with the American Academy of Family Physicians. “For instance, the addition of the word ‘trivalent’ to 90654 is primarily for the purposes of distinguishing it from new code 90630, which is a quadrivalent vaccine,” Moore adds. 

Embrace the Chronic Care Management (CCM) Improvements

Changes to five CCM codes may make your coding less of a chore.

You will find that CPT® 2015 revises the descriptor for 99487 with bulleted detail as follows: Complex chronic care management services, with the following required elements:

• multiple [two or more] chronic conditions expected to last at least 12 months, or until the death of the patient;
  
• chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  
• establishment or substantial revision of a comprehensive care plan;
  
• moderate or high complexity medical decision making;
  
• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
  

“Adding the elements is definitely a positive; it gives the provider community a set of guidelines to follow to meet the documentation requirements of the codes,” says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. “Often we find that the providers are performing the services, but aren’t necessarily illustrating them as the payer would like to see in the documentation.”

In addition, you’ll see that CPT® 2015 deletes 99488 (Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month).

Don’t miss: the each additional 30 minutes of CCM your physician provides, you will still be able to report revised add-on code +99489 (Complex chronic care management services. . .; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month [List separately in addition to code for primary procedure]).

Bonus: You will also have two new CCM codes to choose from: 

1. 99490 — Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
  
• chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
  
• comprehensive care plan established, implemented, revised, or monitored
  

2. +99498 — ... each additional 30 minutes....

“These changes appear to be primarily in response to the Centers for Medicare & Medicaid Services’ (CMS) proposal to establish its own ‘G’ code for chronic care management along the lines described in code 99490,” Moore says. “It will be interesting to see what CMS decides to do with its proposal in light of the CPT® changes.” 

Read Only 3 Codes for Radiation Therapy Treatment

Beginning January 1, 2015, you will have only three codes for reporting the conventional radiation therapy treatment your physician delivers using a megavoltage beam. These three new codes are: 

• 77402, Radiation treatment delivery, >1 MeV; simple 
  
• 77407, Radiation treatment delivery, >1 MeV; intermediate 
  
• 77412, Radiation treatment delivery, >1 MeV; complex
  

What do the new codes mean for your practice? Until now, you have been reporting radiation therapy codes based on complexity level of megavoltage beam energy. In 2015, you will no longer rely upon the megavoltage beam energy level to define the codes. 

Learn the complexity criteria for new codes: You will choose the new codes based upon simple, intermediate, and complex criteria for radiation therapy. The details of these criteria are below:

• Simple: All of the following criteria are met (and none of the complex or intermediate criteria are met): single treatment area; one or two ports; and two or fewer simple blocks.
• Intermediate: Any of the following criteria are met (and none of the complex criteria are met): two separate treatment areas; three or more simple blocks.
• Complex: Any of the following criteria are met: three or more separate treatment areas; custom blocking; tangential ports; wedges; rotational beam; field-in-field or other tissue compensation that does not meet IMRT guidelines; or electron beam.

In 2015: Strike off the following nine codes from your list:

• 77403, Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6-10 MeV
  
• 77404, …………….11-19 MeV
  
• 77406, ……………….20 MeV or greater
  
• 77408, Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 6-10 MeV 
  
• 77409,………… 11-19 MeV 
  
• 77411,,,,,,,,,,,,,,.. 20 MeV or greater 
  
• 77413, Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 MeV 
  
• 77414, …………11-19 MeV 
  
• 77416,…………….. 20 MeV or greater
  

Editor’s Note: Check out the future issues of the Oncology Coding Alert for more on next year’s CPT® changes.