Relevant, Timely Medical and Radiation Oncology News
Constant advancements in 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.
July 2016 Radiation Oncology News
Radiation Treatment Management
Adam Brown, BSRT(T), CMD
Radiation treatment management (CPT® 77427, 77431, 77432 or 77435) is billed once per five fractions of treatment and depends upon the number and type of treatment(s). Physician documentation of each visit is required. According to CPT coding guidelines, “Radiation treatment management requires and includes a minimum of one examination of the patient by the physician for medical evaluation and management (e.g., assessment of the patient’s response to treatment, coordination of care and treatment, review of imaging and/or lab test results with documentation) for each reporting of the radiation treatment management service.”
Other examples of recommended documentation include, but are not limited to, the following:
- Review of imaging: Statement about any pertinent images (port films, stereoscopic x-ray images, cone beam CT images or U/S images) for the corresponding fraction period has been reviewed by the physician.
- Review of dosimetry and prescription: Statement indicating plan and prescription have been reviewed and are to proceed as outlined, changes have been made and/or new orders provided.
- Examination of patient set-up for treatment: Statement indicating patient’s treatment set-up was reviewed by the physician.
Like other radiation oncology services, guidelines for reporting services can vary per payer. Below are two separate Medicare provider instructions specific to reporting this service.
Weekly management, as instructed by Wisconsin Physician Services Radiation Oncology Including IMRT LCD Coding Guidelines Attachment, states:
“Each unit of service (5 treatment sessions/fractions) of radiation therapy management should be billed on a separate claim line and should be billed with (1) one unit of service in Item 24G of the CMS-1500 claim form or the electronic equivalent. The date of the last treatment session/fraction should be entered as the date of service. “
The Noridian Radiation Oncology Workshop Q&As for April 13, 2011 provided the following instructions:
“What fraction date is required for date of service?
A4. Providers may use either
1) first date of service,
2) last date of service, or
3) date span in Item 24G or electronic equivalent.”
If specific payer instruction is absent, we recommend reporting services consistent with Medicare guidelines.
Stay current on coding updates and documentation requirements the easy way—through Revenue Cycle Inc.’s Client Resource Center. Easily accessible answers are available around the clock, along with a library of resources and articles. To find out about an annual subscription and all of our consulting services, please contact us at www.revenuecycleinc.com or 512-583-2000.
June 2016 Medical Oncology News
New January 3, 2017 Effective Date for the JW Modifier
Gigi Price, R.N., O.C.N., CHONC
The requirements for the use of the JW modifier are changing—is your organization ready? Historically, the JW modifier has been available for reporting drug waste from a single dose vial (SDV); however, it hasn’t been required. CMS recently released new guidance on the use of the modifier, outlining the requirements and upcoming implementation dates.
New information was released June 13, 2016, delaying the implementation for use of the JW modifier. CMS issued the following information:
MLN Matters® Number: MM9603 Revised
Related Change Request (CR) #: CR 9603
Related CR Release Date: June 9, 2016
Effective Date: January 1, 2017
Related CR Transmittal #: R3539CP
Implementation Date: January 3, 2017
“Transmittal 3530, dated May 24, 2016, is being rescinded and replaced by Transmittal 3538 to update the Effective and Implementation dates. All other information remains the same.”
“The official instruction, CR9603, issued to your MAC regarding this change is available here.”
The following was published within MLN Matters® Number: MM9603, April 29, 2016 and was updated June 9, 2016, JW Modifier: Drug Amount Discarded/Not Administered to any Patient. The effective date is January 1, 2017, and the implementation date is January 3, 2017.
“The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 9603 to alert MACs and providers of the change in policy regarding the use of the JW modifier for discarded Part B drugs and biologicals.
Effective January 1, 2017, providers are required to:
- Use the JW modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals) and
- Document the discarded drug or biological in the patient's medical record when submitting claims with unused Part B drugs or biologicals from single use vials or single use packages that are appropriately discarded
Make sure that your billing staffs are aware of these changes. Remember that the JW modifier is not used on claims for CAP drugs and biologicals.”
In addition, CR 9603 published the July 1, 2016, changes to Medicare Claims Processing Manual, Chapter 17 - Drugs and Biologicals, regarding the use of the JW modifier and updated it on June 9, 2016. An excerpt is provided here for reference:
"Effective January 1, 2017 when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP)), local contractors shall require the use of the modifier JW to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological. For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units shall be billed on another line by using the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient’s medical record.
The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.”
Keeping your organization in tune with frequent coding changes can be a tough task for compliance to maintain. To make sure you’re not only compliant but also receiving proper payment, it’s vital that everyone in your organization is up-to-date on how to use the JW modifier. We can train your pharmacy, nursing, coding, billing and IT staff—anyone responsible throughout the process of care—on the details, and streamline communications between pharmacy and billing. The experts at Revenue Cycle, Inc. are here to help—from compliance and staff education to documentation and coding reviews. For more information regarding RCI’s services, please contact our consulting team at 512-583-2000 or email@example.com.