Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

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Medical Oncology Code Changes

ACOA Coding Minute

New Category III CPT Codes

Effective January 1, 2006 there will be new Category III CPT codes for medication therapy management services (MTMS).  According to the CPT Manual, Category III CPT codes are a “set of temporary codes for emerging technology, services, and procedures.”  The intent of these codes is data collection, and these services may or may not be reimbursed by insurance.  MTMS services describe:

  • Face-to-face patient assessment, and
  • Intervention as appropriate

  • When performed by a pharmacist.

MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.  MTMS includes documented:

  • Review of pertinent patient history, and
  • Medication profile (prescription and non-prescription), and
  • Recommendations for improving health outcomes and treatment compliance.

These codes are not used to describe the provision of product-specific information or any other routine dispensing activity.  Effective January 1, 2006 the new codes include:

  0115T

  • Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, initial 15 minutes, with assessment, and intervention if provided; initial encounter

  0116T

+0117T

  • Each additional 15 minutes

Additional information is located at: www.ama-assn.org/ama/pub/category/3885.html

Watch for more 2005 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates from the Academy’s Website.

This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.

Phone: (877) 6CODING

Fax: (770) 445-0407

[email protected]
www.codingstrategies.com

Cindy C. Parman, CPC, CPC-Hcparman-1058412
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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