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.

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

Targeted Treatment

Gigi Price, R.N., O.C.N., CHONC

Advances in oncology that we’re seeing today, such as targeted treatment, would have sounded like science fiction 30 years ago.  The age of personalized treatments—for example, drugs that target specific molecular aspects of tumors—is here.

Per the American Society of Clinical Oncology (ASCO) article published in July 2015, “The Society Launches the Targeted Agent and Profiling Utilization Registry,” more than 30 drugs are available that are considered to target specific molecular pathways.  In short, these drugs are the arrow shot at the bullseye of a target—cancer cells. This technology allows for personalized treatment specific to the tumor molecular profile.

The majority of these arrow-like drugs are provided in oral formulations.  Below is a snapshot from that ASCO article, with oral and IV added.

Drug, FDA approved indication and target table

If you’ve ever had the privilege of sitting in on or participating in a tumor board meeting then you know one of the areas discussed in the beginning is tumor pathology.  If you’re looking at a newly diagnosed breast cancer, not only do you review the tumor type, but now it’s common that you’ll see the ER/PR status and HER2 status, as well.  The HER2 status is reviewed and results indicating the tumor is positive are required prior to initialization of Trastuzumab (Herceptin).  This is one example of a targeted treatment utilized to treat breast cancer.

A couple of key issues relate to the use of targeted therapies.  First is the need for evidence-based outcomes when the targeted agents are utilized as a treatment option.  The targeted agent may be utilized as a single agent or may be used in conjunction with chemotherapy or other complex drug regimens.  The need for evidence-based data relating to outcomes is critical to the future use of these types of drugs.  When looking at outcomes, adverse events as well as tumor response will need to be taken into account, as indicated by ASCO.

The second issue relates to the fact some of the agents are new and have recently obtained approval from the FDA, so reimbursement for the drug may be a battle.  You must review the language of each payor contract to verify whether the need for prior authorization is required.  We recommend a policy with a pathway to include prior authorization to ensure all steps are completed prior to scheduling a patient to receive treatment.  The policy should also include coding and billing as well as a designated person who will follow the claim from the time it is submitted to the payor until payment is received. Denials must be reviewed as soon as they are received to allow adequate time to provide required evidence-based documentation to support the drug.

Making sure that you follow specific payor guidelines is an important step in your predetermination policy development, especially for new drugs or off-label drug use.  Through staff education, proper documentation and effective checks and balances, you can achieve your goal of maximizing drug reimbursement.  Revenue Cycle, Inc. can help you develop and implement processes that enable you to reach maximum reimbursement goals.  For more information regarding RCI’s services, please contact our consulting team at 512-583-2000.

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

Just Released: 2016 CPT Code Changes

Jennifer Buchanan, B.S., R.T. (R)(T)

On September 1,The American Medical Association (AMA) released the 2016 CPT ® code changes that will go into effect on January 1, 2016.

The most relevant changes for radiation oncology occur within the brachytherapy code set. Regarding high dose rate (HDR) brachytherapy, the code set was revised to differentiate between radionuclide skin, interstitial and intracavitary treatments. CPT® codes 77785 – 77787 were deleted and replaced with 77770, 77771, and 77772. These codes should be used to report HDR brachytherapy for tumors other than skin and are based on the number of channels used to treat the patient.

In addition, two new codes were created to report HDR skin surface brachytherapy: 77767 and 77768. These codes are reported based on one channel or two or more channels or multiple lesions.

The five new codes include the work associated with basic dosimetry calculations (77300) and when performed, are not to be reported with electronic brachytherapy codes. In reference to low dose rate (LDR) brachytherapy, CPT ® codes 77776 and 77777 were deleted and CPT® code 77778 will now be used to report complex LDR brachytherapy cases. The work associated with supervision, handling and loading of the radiation source is now included in code 77778. Therefore, it will no longer be appropriate to report CPT® 77790 in conjunction with code 77778.

Electronic brachytherapy code revisions include the deletion of CPT® code 0182T; instead, two new codes were created. CPT® code 0394T will be used to report HDR electronic skin brachytherapy, whereas 0395T will be used to report HDR electronic interstitial or intracavitary treatments. Again, 0394T and 0395T include the basic dosimetry calculation when performed.

In a separate notification, The American Society of Therapeutic Radiation Oncology (ASTRO) anticipates that the Centers for Medicare and Medicaid Services (CMS) will release the values for the new codes around November 1, 2015. Additional coding information will be provided as it is released during the reminder of the year.

To ensure your practice and facility remain abreast of the latest updates and code changes, Revenue Cycle Inc. provides ongoing consulting services through our Client Resource Center. For more information on an annual subscription and all of our services, please contact us at

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

CY2016 Proposed Rules for Radiation Oncology Released

The CY2016 Proposed Rules for Radiation Oncology contained many potential changes to the Medicare Physician Fee Schedule including the proposed conversion factor, practice expense and malpractice updates, misvalued codes, radiation treatment and related image guidance services and more. Hospital Outpatient Prospective Payment System highlights are comprised of changes to the payment rates, APC names/codes, C-APC for SRS procedures and the new HCPS codes to be released in August. The Revenue Cycle Inc. team has thoroughly reviewed and condensed the proposed changes for the radiation oncology industry into two documents. Within these summations are examples of potential reimbursement based on the interpretation of the published ruling. To read the summaries, click on the links below to download a PDF.

CY2016 Proposed Rule for Radiation Oncology – MPFS

CY2016 Proposed Rule for Radiation Oncology – HOPPS

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

CY2016 Proposed Rules for Medical Oncology Released

According to the recent release of the CY2016 Proposed Rules for Medical Oncology, highlights of changes to the Medicare Physician Fee Schedule include adjustments to the conversion factor, misvalued codes and payment for biosimilar biological products. The Hospital Outpatient Prospective Payment System focal points consist of, but are not limited to, changes in the OPPS payment rates for both rural and community hospitals, packaging policies, the conversion factor, payment changes for drugs, biologicals and radiopharmaceuticals and more. The Revenue Cycle Inc. team has comprised a summary of the proposed changes for the medical oncology industry into two documents. To read the summaries, click on the links below to download a PDF.

CY2016 Proposed Rule for Medical Oncology – MPFS

CY2016 Proposed Rule for Medical Oncology – HOPPS