Coding Companion For Oncology/Hematology

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ATHO.book Page 1 Monday, December 1, 2014 12:47 PMCoding Companion forOncology/HematologyA comprehensive illustrated guide to coding and reimbursement

00 ATHO TOC.fm Page i Monday, December 1, 2014 1:21 PMContentsGetting Started with Coding Companion .iGeneral/Integumentary .1Musculoskeletal .41Respiratory .115Cardiovascular .146Hemic/Lymphatic .169Mediastinum .202Digestive .206Urinary .300Male Genital .324Reproductive .339Coding Companion for Oncology/HematologyFemale Genital.340Endocrine .376Nervous .381Radiation Oncology .386Nuclear Medicine .423Chemotherapy .426HCPCS .436Appendix .450Correct Coding Initiative Update 20.3 .485Evaluation and Management Codes .555Index.575Contents

47120-4713047120 Hepatectomy, resection of liver; partial lobectomy47122trisegmentectomy47125total left lobectomy47130total right .39277.4571.5ExplanationHCPCS Equivalent CodesN/AMedicare Edits47120471224712547130Fac RVUNon-Fac 95.1690909090AAAA2(3)1(2)1(2)1(2)Coding TipsIf significant additional time and effort is documented, append modifier 22and submit a cover letter and operative report.ICD-9-CM nt neoplasm of liver, primaryMalignant neoplasm of liver, not specified as primary or secondarySecondary malignant neoplasm of liverMalignant carcinoid tumor of other sites — (Code first any associatedmultiple endocrine neoplasia syndrome: 258.01-258.03)(Useadditional code to identify associated endocrine syndrome, as:carcinoid syndrome: 259.2)Malignant poorly differentiated neuroendocrine carcinoma, anysite — (Code first any associated multiple endocrine neoplasiasyndrome: 258.01-258.03)(Use additional code to identify associatedendocrine syndrome, as: carcinoid syndrome: 259.2)Benign carcinoid tumor of other sites — (Code first any associatedmultiple endocrine neoplasia syndrome: 258.01-258.03)(UseCPT 2015 American Medical Association. All Rights Reserved.Coding Companion for 12551N/A4713051N/A* with documentation62*62*62*62*Medicare Reference80808080None 2015 Optum360, LLCDigestive — 277DigestiveThe physician removes a section of liver, or lobectomy. The physician exposesthe liver via an upper midline incision through skin, fascia, and muscle. Thefibrous connections of the liver to the diaphragm are divided and the portalstructures are controlled. The portal and hepatic vessels associated with theaffected lobe are divided. The portal structures are clamped. The liverparenchyma is divided by pressure or coagulation hemostases. The portalclamp is removed and hemostasis is assured before the abdomen is closedwith sutures. Report 47120 if a partial lobectomy is performed; report 47122if a trisegmentectomy is performed; report 47125 if a total left lobectomy isperformed; and report 47130 if a total right lobectomy is .69782.4789.1additional code to identify associated endocrine syndrome, as:carcinoid syndrome: 259.2)Secondary neuroendocrine tumor of liverBenign neoplasm of liver and biliary passagesCarcinoma in situ of liver and biliary systemNeoplasm of uncertain behavior of liver and biliary passagesNeoplasm of unspecified nature of digestive systemAmyloidosis, unspecified — (Use additional code to identify anyassociated intellectual disabilities)Familial Mediterranean fever — (Use additional code to identifyany associated intellectual disabilities)Other amyloidosis — (Use additional code to identify any associatedintellectual disabilities)Disorders of bilirubin excretion — (Use additional code to identifyany associated intellectual disabilities)Cirrhosis of liver without mention of alcohol — (Code first, ifapplicable, viral hepatitis (acute) (chronic): 070.0-070.9)Biliary cirrhosisOther chronic nonalcoholic liver diseaseAbscess of liverOther specified disorders of liverOther specified disorders of biliary tractUnspecified congenital anomaly of gallbladder, bile ducts, and liverCongenital cystic disease of liverOther congenital anomaly of gallbladder, bile ducts, and liverJaundice, unspecified, not of newbornHepatomegaly

G0396-G0397G0396 Alcohol and/or substance (other than tobacco) abuse structuredassessment (e.g., AUDIT, DAST), and brief intervention 15 to 30minutesG0397 Alcohol and/or substance (other than tobacco) abuse structuredassessment (e.g., AUDIT, DAST), and intervention, greater than 30minutesExplanationAlcohol and substance abuse may be assessed by several different methods,including a drug abuse screening test (DAST) and an alcohol use disorderidentification test (AUDIT).7701477014 Computed tomography guidance for placement of radiation therapyfieldsExplanationComputed tomography (CT) is used in guiding the placement of radiationtherapy fields. CT scanning directs multiple narrow beams of x-rays around thebody structure being studied and uses computer imaging to produce thincross-sectional views of various layers (or slices) of the body. It is able to visualizesoft tissue, as well as bones. Patients are required to remain motionless duringthe study. Cross-sectional images of both normal and abnormal tissue structuresare obtained and the treatment field area volume is determined. The normaltissues surrounding the treatment area are also defined. Acquiring this data isan important step in planning the patient's radiation treatment.77074-7707577074 Radiologic examination, osseous survey; limited (eg, for metastases)77075complete (axial and appendicular skeleton)ExplanationVarious bones in the body are x-rayed. A limited study is reported (77074) whenspecific symptomatic sites are examined. This procedure is rarely performed todetermine any spread of cancer, having been replaced by nuclear bone scanning,a more precise study for diagnosing metastases. A complete study (77075) iswhen the axial (head and trunk) and appendicular (extremities) skeleton issurveyed for evidence of metastatic disease. It may also be performed on childrento identify current and/or old healed fractures in the case of suspected childabuse. This procedure is rarely performed for metastatic disease, having beenreplaced by nuclear bone scanning, a more precise study for diagnosingmetastases.[77387]77387 Guidance for localization of target volume for delivery of radiationtreatment delivery, includes intrafraction tracking, when performedExplanation77055 Mammography; unilateral77056bilateral77057 Screening mammography, bilateral (2-view film study of each breast)Radiation treatment delivery involves the transfer of a beam of radioactiveelectromagnetic energy from a treatment machine distanced from the treatmentarea. Stereotactic body radiation therapy is a radiation therapy techniquedesigned to deliver a large radiation dose to discrete tumor sites in the lungs,liver, brain, or elsewhere while minimizing damage to healthy tissue. Stereoscopicx-ray guidance utilizes infrared and/or camera technology to precisely localizetargets in conjunction with intensity modulated radiation therapy and stereotacticradiotherapy. This code reports the guidance for localization of target volumefor treatment delivery and includes intrafraction tracking, when performed.ExplanationCoding Tips77055-77057AppendixMRI. The patient must remain still while lying on a motorized table within thelarge, circular MRI tunnel. A sedative may be administered, as well as an IVinjected contrast material for image enhancement. Report 77058 for magneticresonance imaging of the left or right breast and 77059 for both breasts.Mammography is a radiographic technique used to diagnose breast cysts ortumors in women with symptoms of breast disease or to detect them beforethey are palpable in women who are asymptomatic. Mammography is doneusing a different type of x-ray than is used for routine exams that do notpenetrate tissue as easily. The breast is compressed firmly between two planesand pictures are taken. This spreads the tissue and allows for a lower x-ray dose.Use 77055 for a single breast and 77056 for both breasts. Report 77057 forboth breasts done in an asymptomatic screening with two views taken of eachbreast.77058-7705977058 Magnetic resonance imaging, breast, without and/or with contrast77059material(s); unilateralbilateralExplanationMagnetic resonance imaging (MRI) is a radiation-free, noninvasive techniqueto produce high-quality sectional images of the inside of the body in multipleplanes. MRI uses the natural magnetic properties of the hydrogen atoms in ourbodies that emit radiofrequency signals when exposed to radio waves within astrong electromagnetic field. These signals are processed and converted by thecomputer into high-resolution, three-dimensional, tomographic images. Patientswith metallic or electronic implants or foreign bodies cannot be exposed to 201 Optum360, LLC450 — AppendixThis code is new for 2015. It replaces 77421 which has been deleted.77422-7742377422 High energy neutron radiation treatment delivery; single treatmentarea using a single port or parallel-opposed ports with no blocks orsimple blocking774231 or more isocenter(s) with coplanar or non-coplanar geometrywith blocking and/or wedge, and/or compensator(s)ExplanationExternal beam radiotherapy is radiation delivered from a distant source outsidethe body and directed at the patient's cancer site. High-energy neutronradiotherapy destroys the cells ability to divide and grow by damaging the cellsthrough nuclear interactions, which decreases the damaged cells chances ofrepairing themselves. Since high-energy neutron radiotherapy works in theabsence of oxygen, unlike conventional radiation therapy, it is used to treatlarger tumors and is particularly effective in treating inoperable salivary glandtumors, bone cancers, and certain types of advanced malignancies of thepancreas, bladder, lung, prostate, and uterus. Due to the high potency of neutronradiation, the required dose is much less than with conventional radiotherapy,and a full course may be delivered in 10 to 12 treatments rather than the usual30 to 40. Report 77422 for a single treatment area using a single port orparallel-opposed ports with no blocks or simple blocking. Report 77423 forCPT 201 American Medical Association. All Rights Reserved.Coding Companion for Oncology/Hematology

ATHO.book Page 555 Monday, December 1, 2014 12:55 PMEvaluation and ManagementAlthough some of the most commonly used codes by physicians ofall specialties, the E/M service codes are among the leastunderstood. These codes, introduced in the 1992 CPT manual,were designed to increase accuracy and consistency of use in thereporting of levels of non-procedural encounters. This wasaccomplished by defining the E/M codes based on the degree thatcertain common elements are addressed or performed and reflectedin the medical documentation.The Office of the Inspector General (OIG) Work Plan for physiciansconsistently lists these codes as an area of continued investigativereview. This is primarily because Medicare payments for theseservices total approximately 33.5 billion per year and areresponsible for close to half of Medicare payments for physicianservices.The levels of E/M services define the wide variations in skill, effort,and time and are required for preventing and/or diagnosing andtreating illness or injury, and promoting optimal health. These codesare intended to represent physician work, and because much of thiswork involves the amount of training, experience, expertise, andknowledge that a provider may bring to bear on a given patientpresentation, the true indications of the level of this work may bedifficult to recognize without some explanation.At first glance, selecting an E/M code may appear to be difficult, butthe system of coding clinical visits may be mastered once therequirements for code selection are learned and used.ProvidersThe AMA advises coders that while a particular service or proceduremay be assigned to a specific section, the service or procedure itselfis not limited to use only by that specialty group (see paragraphs 2and 3 under “Instructions for Use of the CPT Codebook” on page xiiof the CPT Book). Additionally, the procedures and services listedthroughout the book are for use by any qualified physician or otherqualified health care professional or entity (e.g., hospitals,laboratories, or home health agencies).The use of the phrase “physician or other qualified health careprofessional” (OQHCP) was adopted to identify a health careprovider other than a physician. This type of provider is furtherdescribed in CPT as an individual “qualified by education, training,licensure/regulation (when applicable), and facility privileging(when applicable).” State licensure guidelines determine the scopeof practice and a qualified health care professional must practiceCoding Companion for Oncology/Hematologywithin these guidelines, even if more restrictive than the CPTguidelines. The qualified health care professional may report servicesindependently or under incident-to guidelines. The professionalswithin this definition are separate from “clinical staff" and are able topractice independently. CPT defines clinical staff as “a person whoworks under the supervision of a physician or other qualified healthcare professional and who is allowed, by law, regulation, and facilitypolicy to perform or assist in the performance of a specifiedprofessional service, but who does not individually report thatprofessional service.” Keep in mind that there may be other policiesor guidance that can affect who may report a specific service.Types of E/M ServicesWhen approaching E/M, the first choice that a provider must makeis what type of code to use. The following tables outline the E/Mcodes for different levels of care for: Office or other outpatient services—new patient Office or other outpatient services—established patient Hospital observation services—initial care, subsequent, anddischarge Hospital inpatient services—initial care, subsequent, anddischarge Observation or inpatient care (including admission and dischargeservices) Consultations—office or other outpatient Consultations—inpatientThe specifics of the code components that determine code selectionare listed in the table and discussed in the next section. Before alevel of service is decided upon, the correct type of service isidentified.Office or other outpatient services are E/M services provided in thephysician or other qualified health care provider’s office, theoutpatient area, or other ambulatory facility. Until the patient isadmitted to a health care facility, he/she is considered to be anoutpatient.A new patient is a patient who has not received any face-to-faceprofessional services from the physician or other qualified healthcare provider within the past three years. An established patient is apatient who has received face-to-face professional services from thephysician or other qualified health care provider within the pastthree years. In the case of group practices, if a physician or otherqualified health care provider of the exact same specialty orsubspecialty has seen the patient within three years, the patient isconsidered established.If a physician or other qualified health care provider is on call orcovering for another physician or other qualified health careprovider, the patient’s encounter is classified as it would have beenby the physician or other qualified health care provider who is notavailable. Thus, a locum tenens physician or other qualified healthcare provider who sees a patient on behalf of the patient’s attendingEvaluation and Management — 555Evaluation and ManagementThis section provides an overview of evaluation and management(E/M) services, tables that identify the documentation elementsassociated with each code, and the federal documentationguidelines with emphasis on the 1997 exam guidelines. This set ofguidelines represent the most complete discussion of the elementsof the currently accepted versions. The 1997 version identifies bothgeneral multi-system physical examinations and single-systemexaminations, but providers may also use the original 1995 versionof the E/M guidelines; both are currently supported by the Centersfor Medicare and Medicaid Services (CMS) for audit purposes.

A comprehensive illustrated guide to coding and reimbursement ATHO.book Page 1 Monday, December 1, 2014 12:47 PM . a more precise study for diagnosing metastases. . Coding Companion for Oncology/Hematology Evaluation and Management — 555 Evaluation and Management

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