Oncology & Hematology Coding Alert

The latest edits to Medicare's Correct Coding Initiative (CCI) will have little effect on oncology and radiation oncology practices, according to the American Society of Clinical Oncology's public policy and practice department.
 
Carriers rely on the changes to determine whether certain codes should be paid separately or bundled. This remains unchanged in the three major categories most relevant to oncology chemotherapy administration, bone marrow biopsies, and radiation oncology.
 
For example, chemotherapy administration codes such as 96410 (infusion technique, up to one hour) can be coded separately from E/M codes, such as 99212 (office or other outpatient visit). However, if HCPCS codes for certain supplies appear on the same claim, only 96410 will be paid.
 
While oncologists and CMS disagree over whether bone marrow biopsies and aspirations performed at the same site should be paid separately, the edits remain unchanged. If 85102 (bone marrow biopsy, needle or trocar) and 85095 (bone marrow; aspiration only) appear on the same claim, only 85102 will be paid. The only exception is if modifier -59 (distinct procedural service) is appended to 85095. Oncology practices should check with local carriers to determine what justifies separating the two procedures.
 
CMS developed the CCI to promote correct coding and to control improper coding and reimbursement.