Oncology Coding Changes in CPT 2000
Published on Wed Dec 01, 1999
Coding changes for radiation oncology top the list of new codes and revisions included in the recently released CPT 2000. The change represents a theme to reduce the amount of subjective choices coders must make and allow them to assign a code based on more specific criteria, experts say.
CPT 2000 is very specific and easier to use, says Dianne Willard, RHIA, CCS-P, director of coding products and services for the American Health Information Management Association (AHIMA).
One Code Replaces Four
The new CPT manual includes changes in radiation oncology that simplify the way treatment management is coded. New code 77427 (radiation treatment management, five treatments) replaces CPT 1999 codes 77419, 77420, 77425 and 77430 under clinical treatment management. The deleted codes represented various complexity levels of treatment management.
Because the differences in levels were distinguished by technical nuances and did not necessarily reflect differences in time and effort, the code was simplified, experts say.
For example, discussion of weekly radiation management could be confusing, Willard says. What is the definition of weekly? What if there were only three sessions in a week or one in four weeks? Its much more specific now.
But while coders may find 77427 simpler to use, some are uncertain how it will affect an oncologists bottom line reimbursement. Several radiation oncology treatment management practices fell under codes designated for complex situations that required three or more separate areas to be treated.
Because of the greater complexity, a higher relative value unit (RVU) was assigned to the higher-level codes compared to simple treatment management. With the CPT 2000 consolidation of the treatment management codes, there is concern that the new code, coupled with a smaller RVU, will result in less payment for all treatment management claims, says Cindy Parman, CPC, CPC-H, principal, CSI Consulting, a Dallas, GA-based medical coding consulting firm that includes radiation oncology practices.
The new CPT 2000 code for radiation treatment management also includes revised language to better explain the single codes use. According to the new manual: Radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days. Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy sessions and the fractions are of the character usually furnished on different days.
When fractions are not in units of five, the manual states that this code (77427) should be reported if there are three or four fractions beyond a multiple of five at the end of the course of [...]
