Oncology & Hematology Coding Alert

You can anticipate reforms in mammography, prostate antigen assays, and influenza vaccine codes.

With the New Year fast approaching, it is time to acquaint yourself with the CPT^® 2017 reforms. Here are some anticipated deletions, additions, and revisions that you cannot afford to miss.

Diagnosis Vs Screening Intent Guides Mammography Coding

CPT^® 2017 adds specific codes for diagnostic and screening mammography. "Computer-aided detection ('CAD') has become increasingly commonplace in most radiology centers," says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services ("PERCS"), a division of Pinnacle Healthcare Consulting. "Since coding these two [CAD and mammogram] radiological images had been separate and typically performed together, the codes were combined to include CAD in the imaging service rendered when it is performed."

Depending upon unilateral or bilateral testing, you submit codes 77065 (Diagnostic mammography, including computer-aided detection [CAD] when performed; unilateral) and 77066 (....bilateral) for diagnostic mammography. For screening mammography, you will submit code 77067 (Screening mammography, bilateral [2-view study of each breast], including computer-aided detection [CAD] when performed).

Strike off these mammography codes: The following mammography codes have been deleted:

77051, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure)
77052, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)
77055,             Mammography; unilateral
77056, Mammography; bilateral
77057, Screening mammography, bilateral (2-view study of each breast)

Add These Two New Codes

"Formerly an administrative code in Appendix 'O' Alphanumeric code for Multianalyte Assays with Algorithmic Analysis ("MAAA") 0010M grow up and becomes a regular CPT^® in 2017," Loya says.  You will report 81539 (Oncology [high-grade prostate cancer], biochemical assay of four proteins [Total PSA, Free PSA, Intact PSA, and human kallikrein-2 (hK2)], utilizing plasma or serum, prognostic algorithm reported as a probability score) for assays of prostate antigens in the regular CPT^®  code set. Like before, this code applies to 4 proteins: Total PSA, Free PSA, Intact PSA, and human kallikrein-2.

For exchange transfusion in newborns, you will have a specific new code, 36456 (Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn).

Check Site and Numbers for Neurofibromas

You will have two new Category III CPT^® codes for neurofibroma treatment. Depending upon the anatomical distribution of the neurofibromas and the number of neurofibromas destroyed, you will choose from the following:

• 0419T, Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas
• 0420T, Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas.

Eliminate Age from Influenza Vaccine Codes

CPT^® 2017 instructs not to use age as a parameter for influenza vaccine coding. You will now choose the right code depending upon the dose of the trivalent influenza vaccine.

Make note of these upcoming changes:

• 90655, Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to children 6-35 months of age, 0.25 mL dosage, for intramuscular use
• 90656, Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to individuals 3 years and older, 0.5 mL dosage, for intramuscular use
• 90657, Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6-35 months of age, 0.25 mL dosage, for intramuscular use
• 90658, Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years of age and older, 0.5 mL dosage, for intramuscular use.

Similarly, for quadrivalent influenza vaccines, you will have the following changes:

• 90685, Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to children 6-35 months of age, 0.25 mL dosage, for intramuscular use
• 90686, Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to individuals 3 years of age and older, 0.5 mL dosage, for intramuscular use
• 90687, Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35 months of age, 0.25 mL dosage, for intramuscular use
• 90688, Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3 years of age and older, 0.5 mL dosage, for intramuscular use.

CPT^® 2017 provides distinct codes for trivalent and quadrivalent cell culture derived vaccines. The descriptor of the code 90661 (Influenza virus vaccine, trivalent [ccIIV3], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) will clearly specify trivalent vaccine in dose of 0.5 mL. For quadrivalent cell culture derived vaccine, you will have a new code 90674 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use).