Oncology & Hematology Coding Alert

Report 78804 for diagnostic localization procedures CPT 2004 offers radiation oncology coders two new codes - 78804 and 79403 - for the oncologist's nuclear medicine imaging and infusion therapy services. In addition, oncology coders can now bill implantable pump refills, thanks to new code 95991.
 
Specifically, when your radiation oncologist performs diagnostic tumor localization services or administers a preprocedure study that requires an analysis of radiopharmaceutical distribution, you may assign 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) or 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion).
 
For example, a physician may use radiopharmaceutical localization when testing chemotherapy drugs Zevalin and Bexxar. By using the localization technique, the physician can determine whether the radiopharmaceutical will target a patient's tumor or will concentrate in critical organs, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based coding and consulting firm.
 
And, 78804 and 79403 replace HCPCS codes G0273 (Radiopharmaceutical biodistribution, single or multiple scans on one or more days, pre-treatment planning for radiopharmaceutical therapy of non-Hodgkin's lymphoma, includes administration of radiopharmaceutical [e.g., radiolabeled antibodies]) and G0274 (Radiopharmaceutical therapy, non-Hodgkin's lymphoma, includes administration of radiopharmaceutical [e.g., radiolabeled antibodies]). Therefore, after Jan. 1, you should report either 78804 or 79403 for Medicare patients.
 
CPT 2004 also revised related codes 78800 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; limited area) and 79400 (Radiopharmaceutical therapy, nonthyroid, nonhematologic by intravenous injection), Parman says. Because 78800 and 79400 now represent radiopharmaceutical agent distribution, you can use these codes for the physician's diagnostic tumor localization services, and for radiopharmaceutical localization, depending on the treatment area. Choose 0061T Over Unlisted-Procedure Code In 2004, oncology coders will have a new Category III code to report emerging technologies in malignant breast tumor treatments. Remember that insurers may or may not pay for 0061T (Destruction/reduction of malignant breast tumor including breast carcinoma cells in the margins, microwave phased array thermotherapy, disposable catheter with combined temperature monitoring probe and microwave sensor, externally applied microwave energy, including interstitial placement of sensor), because many payers consider Category III codes to represent experimental procedures, Parman says.
 
Report Category III codes rather than an unlisted-procedure code when the physician performs a procedure he describes, says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CMSCS, a healthcare coding consultant based in Laguna Beach, Calif., and American Academy of Professional Coders National Advisory Board member. Update Your Pump Refill Coding You now have a new code for the oncologist's pump refill services. CPT 2004 adds 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]; administered by physician) so that physicians can report refilling and maintaining implantable pumps or reservoirs [...]