Oncology & Hematology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: In the November Oncology Coding Alert, we read an article on IMRT(intensity-modulated radiation treatment) that stated that until 90 days after the end of treatment, all E/M codes are bundled. However, in a March 2002 training session with Dr. Carl Bogardus, president of the Cancer Care Network in Midwest City, Okla., we were told that there is no longer a global period and that follow-up visits can be billed. Also, our 2002 Medicare provider disclosure report for South Dakota does not list a global period for 77427 (Radiation therapy management, five treatments). Should we be billing these follow-up visits immediately following radiation therapy or not? South Dakota Subscriber  

Answer: In response to the first part of your question, the introduction to the radiation oncology section of the CPTstates that radiation oncology services include follow-up care during the course of treatment and for three months following its completion. We recommend that you follow the CPTguidelines unless specific rules to the contrary are negotiated with your commercial or managed-care payers. In addition, Chapter 18 of the ASTRO/ACR User's Guide contains a listing of all items considered to be included in the weekly treatment management and which are therefore not separately payable. This list includes a specific reference to "follow-up examination and care for 90 days after last treatment (whatever code billed)."

CMS updates the global surgery status list each year; however, this generally refers to surgical services that include a 10- or 90-day follow-up period as part of the total surgical package. Coding questions may arise unless you understand that the absence of a nonsurgical code on this list does not necessarily imply that the requirements of the CPT definitions or the ASTRO/ACR guidelines should be abandoned.

CMS has been asked to make specific comments on this issue for clarification. In the absence of any specific reference to support making such a change in your billing practices and since the ASTRO/ACR guidelines are most often quoted word-for-word in the LMRP don't bill during the 90-day follow-up period unless you have received specific permission in writing from your carrier, or unless there is separate and distinct medical necessity for the E/M service. Answer provided by Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.