Oncology & Hematology Coding Alert

Radiation oncology coders should come prepared when they report 79030 or 79035, because their complicated descriptors confuse many coders - which can lead to errors and claim denials.
 
The differences between 79030 (Radiopharmaceutical ablation of gland for thyroid carcinoma) and 79035 (Radiopharmaceutical therapy for metastases of thyroid carcinoma) lie in whether the patient has primary thyroid cancer (193) restricted to the gland itself, or thyroid cancer that has metastasized to another site in the body, says Nan Schellhaas, RT, radiology coordinator at Pendleton Memorial Methodist Hospital in Dallas.
 
Radiation oncologist coders should remember that 79030 represents primary thyroid cancer, whereas you should report 79035 only if the patient's cancer has spread to another body site.
 
You should report 79030 if your oncologist administers the radionuclide dose to ablate a patient's thyroid gland for primary thyroid cancer, Schellhaas says, but you should report 79035 "for administration of the therapeutic dose to a patient whose thyroid cancer has metastasized." Use 79035 to Represent Metastases  "The most common sites for metastases of primary thyroid cancer are generally the lungs and thorax areas," says Jacqui Szymanski, RT, a radiology technologist at Associated Imaging Specialists in St. Charles, Ill. Will the insurer become suspicious when it determines that you treated thyroid cancer in a site other than the thyroid, such as the lung, even though your claim carries a thyroid cancer diagnosis? Szymanski says no.
 
Although the cancer originated as malignant thyroid cells that were disseminated throughout the body, the "new" cancer site is secondary lung cancer (196.1, Secondary and unspecified malignant neoplasm of lymph nodes; intrathoracic lymph nodes). Your oncologist should list 197.0 (Secondary malignant neoplasm of respiratory and digestive systems; lung) as the first diagnosis and 193 as the secondary diagnosis to indicate that the primary cancer is thyroid cancer. Always Report the Dose In addition to reporting either 79030 or 79035, you should also seek reimbursement for the drug your physician administered, Schellhaas says. "CPT code 79900 (Provision of therapeutic radiopharmaceutical[s]) can be reported in conjunction with both 79030 and 79035 to procure and provide the iodine-131 to the patient. Code 79900, however, is generally replaced with HCPCS code A9603 (Supply of therapeutic radiopharmaceutical, I-131 sodium iodide capsule, per mci) by Medicare carriers." Other insurers may require the HCPCS code, or they may prefer 79900. You should check each individual payer's requirements. Reimbursement for the drugs varies, depending on the amount of the radionuclide needed to either ablate the thyroid gland or treat the metastases, Schellhaas says. You Can Report E/M Codes Because radiation oncologists often administer thyroid ablation radiopharmaceuticals in large doses, your physician may hospitalize the patient for 48 to 72 hours or more. If this is the case, you should report a [...]