Oncology Coding Article – ICD-9-CM diagnosis codes

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Effective October 1, 2002 there were new and updated ICD-9-CM diagnosis codes, with the following code change of particular interest to oncology practices:

V58.42Aftercare following surgery for neoplasm

In addition to the diagnosis code updates, there are new and revised CPT code descriptors that will be effective January 1, 2003:

Radiation Oncology

While changes to CPT codes can be good news when they provide for reimbursement of new technologies, they can also result in additional work required to train staff and update billing systems. There is only one (1) verbiage change in the radiation oncology section for this calendar year, and no new CPT codes or CPT Category III codes. This verbiage change is

77326 Brachytherapy isodose plan; simple (calculation made from single plane, one to four sources/ribbon application, remote afterloading Brachytherapy, 1 to 8 sources)

This minor verbiage change replaces the word “calculation” with “plan,” which accurately reflects the current standard of practice. This verbiage change also affects codes 77327 and 77328.

Medical Oncology

While considered a neurosurgical add-on code, the following new 2003 procedure code describes CNS chemotherapy application:

+61517 Implantation of brain intracavitary chemotherapy agent (List separately in addition to code for primary procedure)

Parenthetical notes accompanying this code indicate that it may only be assigned in addition to 61510 (craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) or 61518 (craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull). A separate note further states: “Do not report 61517 for brachytherapy insertion. For intracavitary insertion of radioelement sources or ribbons, see 77781-77784.”

Remember that even though the diagnosis code changes are officially effective October 1 and procedure code changes effective January 1, 2003, not all payors will accept these codes in that time frame. Certain payors, such as some Medicaid or Worker’s Compensation plans, may require additional time to update their computer systems and recognize these coding changes and additions.

There have been significant changes to procedure codes for bone marrow procedures and related services. Following are the code revisions for this section:

38220 Bone marrow; aspiration only
38221 Bone marrow; biopsy, needle or trocar
New codes added to this section for 2003 include:
38204 Management of recipient hematopoietic progenitor cell donor search and cell acquisition
38205 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogenic  
38206 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous  
38207   Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage  
(For diagnostic cryopreservation and storage, see 88240)  
38208  Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest  
(For diagnostic thawing and expansion of frozen cells, see 88241)  
38209 Transplant preparation of hematopoietic progenitor cells; washing of harvest
38210   Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion  
38211 Transplant preparation of hematopoietic progenitor cells; tumor cell depletion
38212   Transplant preparation of hematopoietic progenitor cells; red blood cell removal  
38213 Transplant preparation of hematopoietic progenitor cells; platelet depletion  
38214  Transplant preparation of hematopoietic progenitor cells; plasma (volume) depletion  
38215 Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer  
38242   Bone marrow or blood-derived peripheral stem cell transplantation; allogenic donor lymphocyte infusions  

A deleted code in this section is 38231 (blood-derived peripheral stem cell harvesting for transplantation, per collection), and the coder is redirected to 38205 or 38206 to report this service.

There has also been a verbiage change to the existing pump refill code and the addition of a new code to clarify whether the medication is administered through the vascular system, or the central nervous system. Effective January 1, 2003 these code descriptors read:

96530 Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)  
95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (Intrathecal, epidural) or brain (intraventricular)

Remember that even though the diagnosis code changes are officially effective October 1 and procedure code changes effective January 1, 2003, not all payors will accept these codes in that time frame. Certain payors, such as some Medicaid or Worker’s Compensation plans, may require additional time to update their computer systems and recognize these coding changes and additions.

Cindy C. Parman, CPC, CPC-Hcparman-7687569
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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