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.

March 2015 Radiation Oncology News (View More News and Articles)

The ABCs of IGRT

By Teresa Allred DeLeon, RT(R)(T), CPC

What happened to image guidance codes for 2015? Why do codes and instructions for hospitals differ from those for physicians and freestanding centers?

Over the past few months we’ve heard these questions asked many times. Significant changes implemented on January 1 have caused a lot of confusion about coding and billing IGRT charges. To help clarify the issue, here’s a quick reference for coding IGRT this year.

For 2015, the American Medical Association (AMA) deleted the previously used IGRT codes, such as CPT® 77421, 0197T and 76950, and a new IGRT code was developed. However, Medicare did not approve this code for use under the Medicare Physician Fee Schedule (MPFS) payment system. As a result, coding between hospitals, physicians and freestanding facilities now differs, which can lead to confusion and potential errors.

In a hospital outpatient setting, rulemaking is defined by the Hospital Outpatient Prospective Payment System (HOPPS), which implemented the new IGRT code developed by the AMA along with new treatment delivery codes. With this change, IGRT is now reported with CPT® 77387. This code is applicable when ordered and medically necessary on 3D conformal patients only, as IGRT is considered bundled in the new IMRT treatment delivery codes. A key change with the new code is the use of it for all forms of IGRT, regardless of the type of imaging or tracking used for target localization.

For a physician or freestanding facility, IGRT is considered billable for 3D conformal and IMRT-based cases when ordered and medically necessary. However, a different set of codes is used when this same procedure is billed in a hospital setting. With the deletion of the previous IGRT codes and the delay in implementation of the new CPT® 77387 and treatment delivery codes for MPFS, Medicare has developed HCPCS codes to be used for IGRT in the interim. They are:

  • G6001 (formerly CPT® 76950) - Ultrasonic guidance for placement of radiation therapy fields
  • G6002 (formerly CPT® 77421) - Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
  • G6017 (formerly HCPCS 0197T) - Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g. 3D positional tracking, gating, 3D surface tracking), each fraction of treatment

In addition, with the intended changes for 2015, CPT® 77014 was stated as no longer applicable for IGRT but was maintained as an active CPT® code as it is used for other services provided in radiation oncology. As a result of the delayed implementation of CPT® 77387 for physicians and freestanding facilities, CPT® 77014 is appropriate for use in this setting to represent CBCT and MVCT-based imaging.  

Compare side-by-side the IGRT coding for HOPPS and MPFS:

2015 HOPPS
(Hospital Outpatient)

2014 CPT® code

2015 MPFS
(Physician and Freestanding)

77387*

76950

G6001

77387*

77421

G6002

77387*

0197T

G6017

77387*

77014

77014

*Billable for 3D conformal cases only

With these changes, it’s important to understand differences in coding as well as the setting in which services are performed and billed. Understanding these factors can help you determine the appropriate IGRT code to report when supported within the medical record.

Keeping up to date with coding changes and rulemaking is vital to maintaining compliant billing practices. Revenue Cycle Inc. offers consulting options for staff education on these and other important issues to ensure your compliance goals are met. We also offer year-round, ongoing support and access to our experts, who have a depth of oncology experience that enables them to help everyone in your facility or practice with answers when they need them. For more information regarding consulting services provided by Revenue Cycle Inc., contact us at info@revenuecycleinc.com

February 2015 Medical Oncology News (View More News and Articles)

Medical Oncology Supervision

By Gigi Price, RN, OCN, CHONC

For practices and facilities across the U.S., the issue of supervision in the medical oncology realm has been, and still is, a conundrum. In a hospital’s outpatient department, exactly who should supervise therapeutic or chemotherapeutic drug procedures has been a topic of interest for several years. Does a physician specifically trained in medical oncology have to be present during the entire procedure? Can a mid-level provider such as a nurse practitioner supervise therapeutic or chemotherapeutic services?

Here’s a little history regarding supervision. In the CY 2000 Outpatient Prospective Payment System final rule, Medicare indicated that direct supervision is the standard for all hospital outpatient therapeutic services covered and paid by Medicare in hospitals and in provider-based departments (PBDs) of hospitals.

CMS created a panel to review various procedures provided in the outpatient setting. Their task was to review supervision requirements of certain therapeutic and chemotherapeutic services, such as injections and infusions.

In March 2014, the CMS Advisory Panel on Hospital Outpatient Payment (HOP Panel) proposed changing the direct supervision requirement for chemotherapy services to general supervision after the patient’s first chemotherapy treatment.

In August 2014, the Panel decided against the proposed supervision requirement change; therefore, chemotherapy administration codes remain under the direct supervision requirement.

If the change is ever adopted, general supervision would indicate the services are furnished under the overall direction and control of the physician or appropriate non-physician practitioner (NPP), but his or her physical presence is not required during the performance of the therapeutic service.

With the current requirement set at direct supervision, the requirements remain for the physician or appropriate NPP (specialty trained) to be immediately available to furnish assistance and direction throughout the performance of a chemotherapeutic service or procedure. However, he or she does not have to be present in the room where the service or procedure is being performed.

Who is considered an appropriate supervisor for these services could vary based upon state-to-state scopes of practice for NPPs. The specific scope of practice should be obtained and evaluated if consideration for an NPP is present.

One thing we can all count on is that policies and rules for procedures are ever-changing. Let the expert consultants at Revenue Cycle Inc. keep you up-to-date and operating with best practices. We’ll analyze your processes and fine tune them to achieve your compliance goals, ensuring that documentation supports clinical practices. For more information regarding Revenue Cycle Inc.’s services, please contact our consulting team at 512-583-2000.