Relevant, Timely Medical and Radiation Oncology News

Constant advancements medical technology and healthcare regulations mean the oncology industry is dynamic and fast-changing. To keep clients on the leading edge of what's happening, Revenue Cycle Inc. maintains the news section of its website as a clearinghouse for oncology news, CPT® coding and/or business operations. Whether it's a legal change that could affect our industry or a tip about oncology coding, you'll find it here.

For more information about how our team of expert consultants can help your practice stay current on these industry changes, visit our medical and radiation oncology service page.

April 2014 Radiation Oncology News (View More News and Articles)

Forgotten But Not Gone: Conventional Isodose Planning Codes

By Adam Brown, BSRT (T), CMD

With the standards of care in radiation oncology changing, conventional isodose planning is used less frequently. As a result, corresponding CPT® codes are overlooked or even forgotten. The codes can be confusing or difficult to use correctly since physicians and staff have changed their focus to other forms of planning, such as 3D, IMRT and stereotactic. 

Conventional isodose planning is reported with CPT® codes 77305, 77310 and 77315 and pertains to cases in which the criteria for 3D, IMRT or stereotactic are not met. These types of plans are most commonly used for metastatic treatments to the brain and bone or areas in which a volume of interest and a critical structure are not defined and used for planning purposes. As defined by the code descriptors, these are divided into simple, intermediate and complex levels based on the complexity of the planning performed and documented. 

The following excerpt is published within the Wisconsin Physics Services Insurance Corporation (WPS) Local Coverage Determination (LCD): Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT).

CPT code 77305 Simple is used when there are one or two ports parallel opposed unmodified ports directed at one volume of interest. 

CPT code 77310 Intermediate is used when there are three or more ports converging on a single volume of interest. Blocking may be utilized to eliminate the beam from certain portions of the isodose plan and must be verified.

CPT code 77315 Complex planning is used when five or more treatment ports converge on a single volume of interest. Complex is used for complex planning and includes mantle or inverted Y fields, compensators, wedges, complex blocking, rotational beam or special beam considerations.” 

Regardless of the type of isodose plan performed, one plan is considered billable per volume of interest; however, multiple isodose plans are billable per course and per date of service. Payors specify a typical course of radiation therapy that may include up to six isodose plans, depending on the medical necessity for the individual case.  

Supporting documentation is also important, as the documentation must detail the number of volumes of interest, beam parameters and support for the level of service billed. In addition, supporting documentation must include physician and physicist signatures. According to the above-referenced WPS LCD, “All isodose plans must be checked and signed by the medical radiological physicist and approved and signed by the radiation oncologist.” 

It is essential that physicians and staff review all appropriate documentation and billing guidelines for this type of planning scenario to ensure that codes are reported correctly. Concise, comprehensive training is a must for any staff performing and documenting these services. And that’s where we come in. Revenue Cycle Inc. consultants can evaluate your current processes and train your staff on correct coding and compliance for conventional isodose planning and other forms of dosimetry planning. Through our Client Resource Center (CRC), our experts are available to help you and your staff all year, any time questions arise. If you would like more information about consulting services provided by Revenue Cycle Inc., contact us at 512-583-2000 or info@revenuecycleinc.com

April 2014 Medical Oncology News (View More News and Articles)

Second Quarter ASP Update

By Gigi Price, RN, OCN, CHONC

As the season changes and the first quarter of 2014 has come to a close, we’d like to remind you that it’s time to review the quarterly Average Sales Price (ASP) Payment Allowance Limits for Medicare Part B Drugs for reimbursement and possible code changes. The ASP quarterly payment file is provided by the Centers for Medicaid and Medicare (CMS) and can be found by clicking here

In this publication, CMS indicates that average drug prices have remained stable and prices for the top Part B drugs have increased by 1.7 percent while the higher-volume drugs changed by 2 percent or less. Payment amounts in these files are 106 percent of the ASP, calculated from data received by drug manufacturers. These variances in pricing are generally tied to this updated data from drug manufacturers. CMS states that they will continue to focus on beneficiary access to Part B covered drugs and therefore continue to monitor trends in pricing and utilization.  

In addition to pricing changes, the second quarter includes new HCPCS codes added to the ASP file with an effective date of April 1, 2014.

As always, new codes mean that the potential for coding and billing errors increases. CMS recommends a quarterly review of these types of changes. Regarding accurate billing of drugs and drug units:

CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.

Like CMS, Revenue Cycle Inc. recommends that you review and update charge masters on a quarterly basis to identify possible reimbursement changes that may affect your practice. It’s also important that your departmental and billing staff are trained on these updates and code changes—including a review of billing and pharmacy inventory systems—to ensure accurate coding of drugs and drug units. As you know, the potential negative effects that can result from your staff not complying with code changes can be serious.

Revenue Cycle Inc. can help you mitigate this risk. We’ll provide you and your staff comprehensive training on code changes, their potential impact on your practice and the appropriate billing processes to accommodate for these changes. Let us keep your practice up-to-date and running smoothly. For information on how we can help, contact us at 512-583-2000 or info@revenuecycleinc.com.