Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

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Transmittal 132, dated March 30, 2004, provides the first quarter update to the Outpatient Prospective Payment System (OPPS). Included in this document are the following:

·        IMRT bundling guidelines are clarified to include only those services performed on the same date (corrects Transmittal 32, December 19, 2003).

·        Hospitals are permitted to use IMRT codes for compensator-based technology.

·        Hospitals are permitted to append modifier –59 to treatment device codes (77332-77334) when billed with an IMRT treatment plan.

·        Code 77790 for supervision, handling, loading of the radiation source may be billed in addition to the code for source application, or the handling and loading charge allowance may be included in the fee for the brachytherapy procedure. Hospitals are instructed not to charge for brachytherapy source storage, since this is considered to be part of the overhead costs.

·        This document also contains a complete, updated list of brachytherapy source “C” codes.

·        Two (2) new codes for breast balloon catheters were added:

o       C9714 – Placement of balloon catheter into the breast for interstitial radiation therapy following a partial mastectomy; concurrent/immediate (add-on)

o       C9715 – Placement of balloon catheter into the breast for interstitial radiation therapy following a partial mastectomy; delayed

In addition, this document includes updates and additions to chemotherapy drug codes, and other regulatory issues relating to medical oncology. The complete document may be reviewed at:

http://www.cms.hhs.gov

Cindy C. Parman, CPC, CPC-Hcparman-6433917
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.  

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