Oncology & Hematology Coding Alert

Plus: A G0354 reporting tip you can't afford to miss CMS has been hard at work coming up with a bevy of new rules for oncology coders. We'll help you wade through your new code options and payment rules so you can capture the reimbursement you deserve. Adjust Your Bilateral Fee Expectations Breast lesion excision codes 19120 and 19125 and eye lesion and biopsy codes 67810, 67840 and 67850, among others, now have a bilateral surgery indicator of 1, meaning the 150 percent payment adjustment applies for bilateral procedures - you get paid the lower of the actual cost or 150 percent of the value of one code. (See the rules on page 143 of the Medicare Claims Processing Manual at www.cms.hhs.gov/manuals/104_claims/clm104c23.pdf.)
 
Each of these formerly had an indicator of 0, meaning the 150 percent adjustment did not apply - you would receive the lower of the actual cost for both or 100 percent of one code. Snag: If you were reporting modifier -59 (Distinct procedural service) for these procedures and getting 100 percent reimbursement for each surgery, the bilateral changes could mean you can expect less money for these services. Keep an eye on your local payer's guidelines to see how it wants you to report these services.
 
You can see the full list of changes to July's 2005 fee schedule update at www.cms.hhs.gov/manuals/pm_trans/R558CP.pdf. Counsel Smokers? Try These New Codes You've also got two new G codes for tobacco cessation counseling under July's 2005 fee schedule update. To report these new codes, the patient must receive information beyond your typical E/M. Medicare will cover two attempts per year, with a maximum of four sessions each. Code G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) has a miniscule nonfacility PE RVU of 0.09, and G0376 (...intensive, greater than 10 minutes) has a nonfacility PE RVU of 0.18.
 
You can find the details at www.cms.hhs.gov/manuals/pm_trans/R36NCD.pdf and www.cms.hhs.gov/manuals/pm_trans/R562CP.pdf. Note: You also have older Category II CPT codes for smoking assessment and counseling, but these typically don't offer any reimbursement. Test Your New ICD-9 Knowledge Starting Oct. 1, 2005, you'll be able to report three new diagnosis codes for genetic testing and counseling:

V26.31 - Testing for genetic disease carrier status
V26.32 - Other genetic testing
V26.33 - Genetic counseling. Don't miss: Once these new codes go into place, V26.3 (Genetic counseling and testing) will be invalid.
 
More changes: You now report volume depletion for dehydration, but starting in October physicians will have to distinguish between unspecified volume depletion (276.50), dehydration (276.51) and hypovolemia (276.52).
 
The new codes should help oncologists track dehydration specifically.
 
You can check out the full list of proposed [...]