Oncology & Hematology Coding Alert

The deletion will retroactively apply to claims effective Jan 1.

Facilities providing services in radiation oncology have been confused about the edit introduced for radiotherapy planning procedures and the calculation of basic dosimetry by the CMS earlier this year. CMS has now decided to revisit the edit, and here's how it will affect you.

You may have noticed a commotion about reporting the following two codes:

• 77300, Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician.
• 77295, 3dimensional radiotherapy plan, including dosevolume histograms.

What does the current edit imply? With this edit was implemented on January 1, 2016, you cannot not bill code 77300 and 77295 together as code 77300 was considered integral to the 3D plan. Hence, hospitals, physicians or freestanding cancer centers cannot submit the two codes together due to the procedure-to-procedure edit.

What does the new CMS decision imply? CMS has announced that it will delete the code edit for 77300 and 77295 effective July 1st this year. This edit deletion will apply from January 1, 2016, which was also the implementation date of the edit. This means that the edit announced earlier this year will no longer apply and you needn't have different submissions in the first and second halves of this year. You can go back and rectify all your claims and submit retroactive charges in accordance with documentation guidelines. Providers should continue to keep record and capture the supported work of code 77300 during the 3D planning process.

Why this change? The CMS has decided to revise this recent edit to reciprocate to requests from professional societies like American College of Radiology (ACR), American Society of Radiation Oncology (ASTRO) and American Association of Physicists in Medicine (AAPM).

Also: CMS will revise the National Correct Coding Initiative Policy Manual for Medicare (Medicaid) Services, Chapter IX (Radiation Oncology), subsection 17 of the 2017 version of the Manual.

Resource: You can read about this edit decision in the letter from the NCCI medical director to ACR and ASTRO at http://www.acr.org/~/media/ACR/Documents/PDF/Economics/astroacr030116_77295w77300 (2).pdf.

Editor's note: This correction will appear in the NCCI's July 1, 2016 quarterly update, and you can keep a watch on future updates.