Oncology & Hematology Coding Alert

Performed both bone marrow aspiration and biopsy? Report only one code next year.

Fall is officially here, which means 'tis the season for CPT^®'s latest round of additions, revisions, and deletions - and if you want to be ahead of the game, you've got to learn what will impact your oncology practice sooner rather than later.

Check out these five coding areas that will impact your oncology claims, ranging from oncology surgeries to ablation therapy.

1. Transform How You Report Bone Marrow Aspirations

Among the biggest news for oncology is how you'll report aspiration procedures, says Kelly Loya, CPhT, CPC-I, CHC, CRMA,  Managing Directorof Pinnacle Enterprise Risk Consulting Services. You'll need to select the appropriate code based on the aspiration's purpose.

First of all, you have the new code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)). You'll find revisions for current codes 38220 (Bone marrow; aspiration(s)) and 38221 (Bone marrow; biopsy(ies)). Notice how the new code combines both the biopsy and aspiration, whereas 38220 and 38221 separate these procedures out.

Example: Suppose your oncologist performs a diagnostic bone marrow aspiration and also takes a biopsy sample, you'll report only 38222.

Heads up: Currently, "you'll report both 38220 and 38221 for non-Medicare patients. On the other hand, for Medicare patients, you would report 38221 and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service), so we'd expect Medicare deletes G0364 in 2018," Loya says.

2. Zero In on These Radiologic Examinations

When your oncologist orders some radiologic exams for their patients, you've got some new codes at your disposal.

Chest: Say so long to chest x-ray codes71010-71035. You'll report these services based on the number of views next year:

• 71045 (Radiologic examination, chest; single view).
• 71046 (...; 2 views).
• 71047 (...; 3 views).
• 71048 (...; 4 or more views).

Abdomen: X-rays of the abdomen will receive the same treatment. Codes74000-74020will be deleted and replaced by the following codes:

• 74018 (Radiologic examination, abdomen; 1 view).
• 74019 (...; 2 views).
• 74021 (...; 3 or more views).

3. Look At What's New - And Deleted - For Oncology Surgeries

You've got several oncology surgery changes to note.

First of all, you'll find a new add-on code to apply for your partial mastectomy procedures, which is +19294 (Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)).

However, you'll need to strike out these oncology surgery category III codes. They will no longer be valid after Jan. 1:

• 0301T (Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance)
• 0340T (Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance).

4. Don't Miss This Add-on Ablation Therapy Code

You'll need to distinguish your ablation therapy after Jan. 1. You'll need to add 32994 (Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation).

5. Take Note of These Derm Additions

If your oncologist sees skin cancer patients, you should highlight these two codes:

• 96573 (Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day)
• 96574 (Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day)

Bonus: Hematology Practices Should Delete This Code

If your practice handles hematology services, you'll need to delete the following code as of Jan. 1:

• 36515 (Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion)