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.
May 2016 Radiation Oncology News
Electron Planning – What Do I Charge?
Adam Brown, BSRT(T), CMD
As a dosimetrist, I never knew what to charge when I did an electron plan. I was told, “Just bill it as a complex plan.” Many of the current payers provide excellent guidance on the appropriate codes to report when fabricating an electron plan. According to Noridian Healthcare Solutions, LLC Radiation Oncology: External Beam /Teletherapy (L24354):
“Special Teletherapy Port Plan (CPT code 77321)
This code is utilized when planning for any special beam consideration is required (e.g. electrons, heavy particles). Some examples include the use of electrons in total skin irradiation, photons for hemibody irradiation, and proton or neutron beam therapy planning.
Note that an isodose plan is an integral piece of documentation for work effort on this planning code. If a particle beam is planned for delivery without an isodose plan, then 77300 should be assessed. An isodose plan need not be developed for hemibody, total body proton or total skin electron plans.
The radiation oncologist must document his/her involvement in the planning and selection of the special beam parameters and must make the final selection and initiation of the treatment process.”
Based on the above, it’s important to make sure the medical record reflects payer instructions for appropriate electron isodose planning. However, as also indicated above, there are different electron processes, such as clinical versus computer-based design and planning. Because of these differences, the corresponding CPT® coding and medical record documentation can vary greatly, including components such as simulations, planning and calculations.
Revenue Cycle Inc. offers a range of medical record review services as well as education and training to help you ensure your electron coding and documentation processes are accurate and compliant. For more information, please contact us at 512-583-2000 or www.revenuecycleinc.com.
April 2016 Medical Oncology News
Gigi Price, R.N., O.C.N., CHONC
Throughout the year, the FDA receives new data submitted by pharmaceutical manufacturers and research entities. After their intensive review of it, the FDA grants labeling changes to existing approved drugs, adds new indications for use, initiates an accelerated approval, proceeds with regular approval or decides more information is required from related research entities prior to granting approval for use in humans. The following is a synopsis of the new drug Inflectra, commonly provided in the Infusion setting.
Inflectra is manufactured by Celltrion, Inc., based in Yeonsu-gu, Incheon, Republic of Korea, for Hospira, of Lake Forest, Illinois. Remicade® is marketed by Janssen Biotech, Inc., based in Horsham, Pennsylvania. It is the second company to receive approval of a biosimilar (a product similar to an FDA-approved drug) in the U.S. through the new FDA biosimilars pathway established under the Biologics Price Competition and Innovation Act. Recently, the FDA approved Inflectra, a biosimilar to Remicade, for multiple indications. The formulation of Inflectra differs from that of U.S.-licensed Remicade in one inactive component. The product is not yet available in the U.S. market due to ongoing patent litigation. Inflectra is utilized in:
- Adult patients and pediatric patients (ages six years and older) with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy
- Adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy
- Patients with moderately to severely active rheumatoid arthritis in combination with methotrexate
- Patients with active ankylosing spondylitis (arthritis of the spine)
- Patients with active psoriatic arthritis
- Adult patients with chronic severe plaque psoriasis
Inflectra for injection is supplied in an accumulator carton containing 10 vials of 100 mg. Each single use vial contains 100 mg of infliximab-dyyb. Billing and coding includes the use of code Z51.12, indicating immunotherapy, followed by the diagnosis code. The CMS HCPCS update of April 6, 2016, indicated Q5102 per 10 mg will be effective July 1, 2016. More information can be found here.
Prior to July 1, 2016, it is best to check with individual payers for guidance when using the unclassified code J9999 chemotherapy or J3590 unclassified biologic, depending on payer requirements and the setting in which the drug is provided.
Keeping up-to-date with FDA approvals and accurate coding, and adhering to specific payer guidelines are important steps in every documentation and billing compliance plan. With timely staff education, proper documentation, and effective checks and balances, you can achieve your compliance goals. Revenue Cycle Inc. can help by implementing efficient processes. For more information regarding RCI’s services, please contact our consulting team at 512-583-2000.