How ICD-10 Affects Radiation Oncology. Presented by, Lashelle Bolton CPC, COC, CPC-I, CPMA

Transcription

1 How ICD-10 Affects Radiation Oncology Presented by, Lashelle Bolton CPC, COC, CPC-I, CPMA

2 ICD-10 ICD-10-CM has added new challenges to the radiation oncology specialty. Approximately 220 ICD-9-CM codes in the malignancy section for radiation therapy, the new code set now renders over 1,700 malignancy code choices. The factors most utilized include location and laterality.

3 ICD-10 Code set C00- D49 Guidelines Not many 1:1 codes

4 Neoplasms Benign Malignant o Secondary In situ Uncertain behavior o o C codes (malignant) D codes (In situ, benign, uncertain behavior)

5 Coding ICD-10 Manual Consultation Report Pathology

6 Guidelines Anemia associated with malignancy When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

7 Guidelines Management of dehydration due to the malignancy When the admission/encounter is for management of dehydration due to the malignancy and only the dehydration is being treated (intravenous rehydration), the dehydration is sequenced first, followed by the code(s) for the malignancy.

8 Guidelines Disseminated malignant neoplasm, unspecified Code C80.0, Disseminated malignant neoplasm, unspecified, is for use only in those cases where the patient has advanced metastatic disease and no known primary or secondary sites are specified. It should not be used in place of assigning codes for the primary site and all known secondary sites.

9 Guidelines Malignant neoplasm without specification of site Code C80.1, Malignant (primary) neoplasm, unspecified, equates to Cancer, unspecified. This code should only be used when no determination can be made as to the primary site of a malignancy. This code should rarely be used in the inpatient setting.

10 ICD-10 An example of the exploding code choices is found in malignant neoplasm, female breast. In ICD-9-CM, this sub-section had six codes. ICD-10- CM, there are 18 codes to choose from.

11 ICD-10 Anatomical Location ICD-9 ICD-10 Nipple Right C Nipple Left C Nipple Unspecified C Central Right C Central Left C Central Unspecified C Upper Inner Right Quadrant C Upper Inner Left Quadrant C Upper Inner Unspecified C Quadrant Lower Inner Right Quadrant C Lower Inner Left Quadrant C Lower Inner Unspecified C Quadrant Upper Outer Right Quadrant C Upper Outer Left Quadrant C Upper Outer Unspecified C Quadrant Lower Outer Right Quadrant C Lower Outer Left Quadrant C Lower Outer Unspecified Quadrant C50.519

12 Payment For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes. This is NOT a free pass

13 Modalities & ICD-10 Brachytherapy SRS/SBRT IORT

14 Brachytherapy A modality of treatment by which radioactive sources (seeds) are utilized to deliver radiation near the tumor or target area. Sources may be sealed or unsealed Sealed sources are delivered through applicators Unsealed sources are delivered orally, by injection, or by instillation into body cavities.

15 Brachytherapy Categorized in three ways: Rate Anatomical Position Complexity

16 Brachytherapy Rate LDR- Low dose rate 2 Gy per hour HDR- High dose rate > 12 Gy per hour Medium dose rate (less commonly used)

17 Low Dose Rate (LDR) Brachytherapy Longer exposure time when afterloading Utilized for permanent seed implant cases Utilized in treatment of Thyroid cancer Used in Interstitial applications May be permanent or temporary

18 High Dose (HDR) Brachytherapy Used frequently for gynecological cases Referred to as remote afterloading Requires placement of catheters, needles or other applicators Also used after balloon angioplasty Usually administered in a series of fractions Always a temporary implant

19 HDR Brachytherapy Advantages: Short treatment time Ease of use Reliable Q/A Personnel safety Common Sources Iridium 192 Cesium 137

20 Brachytherapy Anatomical Position Interstitial- directly inserted into tumor Intracavitary-inserted into a body cavity Surface application- placed directly on the external surface area. Ex. eye, skin or breast

21 Brachytherapy Complexity LDR- determined by number of sources HDR- determined by number of channels

22 LDR Brachytherapy Sources o Palladium 103 o Iodine 125 o Cesium 131 o Gold 198 o Iridium 192 o Cesium 137

23 Brachytherapy Isodose Plans Identifies the radiation distribution surrounding one or more brachytherapy radioactive sources. Determines the exact distribution of radiation to the treatment volume and adjacent normal structures around the brachytherapy sources. May be reported more than once during the course of treatment.

24 Radiation Oncology Brachytherapy Isodose Planning o Codes were identified as being reported with basic dosimetry calculations over 75% of the time Deleted Codes New Codes Brachytherapy isodose plan; simple, includes basic dosimetry calculations Intermediate Complex 24

25 Radiation Oncology Brachytherapy isodose plan; simple (calculation(s) made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation (s) Brachytherapy isodose plan; intermediate (calculation(s) made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation (s) Brachytherapy isodose plan; complex (calculation(s) made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation (s) 25

26 LDR Brachytherapy Treatment Location: Intracavitary CPT Codes Number of Sources CPT Code Description 1 to Intracavitary radiation source application; simple 5 to Intracavitary radiation source application; intermediate Over Intracavitary radiation source application; complex Location: Interstitial Number of Sources CPT Code Description 1 to Interstitial radiation source application; simple 5 to Interstitial radiation source application; intermediate Over Interstitial radiation source application; complex

27 HDR Treatment Delivery HDR: Simple * 1 Channel

28 HDR Treatment Delivery HDR: Intermediate * 2 12 Channels

29 HDR Treatment Delivery HDR: Complex * Over 12 Channels

30 HDR Treatment Delivery Coding Note.. When services are performed in POS 21 or 22, or other facility setting, physicians reporting these codes must use modifier 26, professional component.

31 Example: Vaginal HDR Physician Visit & Facility Visit Physician Clinical Plan Special Treatment Procedure 99XXX-99XXX Or 99XXX-99XXX Clinical Treatment Plan Note justifying the use of this code Simulation, Calculations & Devices or Brachytherapy Plan Starting with treatment delivery Brachytherapy Treatment Delivery Insertion Code Radiation Source C1717

32 Brachytherapy Surgical Procedure Codes (Applicable to LDR & HDR) Anatomical Region CPT Code Description Skin Unlisted procedure, skin Breast Placement of expandable catheter, on different date of partial mastectomy. Breast Placement of expandable catheter, on same date of partial mastectomy. Breast Use for multiple tube or button type brachytherapy. Trachea & Bronchi Bronchoscopy, rigid or flexible

33 Brachytherapy Surgical Procedure Codes (Applicable to LDR & HDR) Anatomical Region CPT Code Description Lung Bronchoscopy, rigid or flexible with placement of catheter Lung Placement of interstitial device for radiation therapy guidance, single or multiple Head & Neck Placement of needles, catheters, or device into the head and/or neck region Head & Neck 0190T Placement of intraocular radiation source applicator

34 Brachytherapy Surgical Procedure Codes (Applicable to LDR & HDR) Anatomical Region CPT Code Description Upper Gastrointestinal Upper gastrointestinal endoscopy, with tube or catheter placement Abdomen, Peritoneum & Omentum Placement of interstitial device(s) for radiation therapy Female Genital Placement of needles or catheters into pelvic organs for subsequent interstitial radioelement application

35 Brachytherapy Surgical Procedure Codes (Applicable to LDR & HDR) Anatomical Region CPT Code Description Female Genital Insertion of uterine tandem and or/ vaginal ovoids. Female Genital Insertion of Heyman capsules Female Genital Unlisted procedure, female genital system Prostate Transperineal placement of needles or catheters into prostate

36 Surface Application Brachytherapy Isodose Plans o Treatment Delivery Clinical example- Postoperative treatment of pterygium Documentation is a procedure or operative note.

37 Coding Complexities Corpus uteri, except isthmus Included endometrium, fundus & myometrium C54 Malignant neoplasm of corpus uteri o o o o o C54.0 Malignant neoplasm of isthmus uteri (lower segment) C54.1 Malignant neoplasm of endometrium C54.2 Malignant neoplasm of myometrium C54.8 Malignant neoplasm of overlapping sites of corpus uteri C54.9 Malignant neoplasm of corpus uteri, unspecified Concerns: Documentation Specificity

38 Coding Complexities Malignant Neoplasm of fallopian tube C57.0 Malignant Neoplasm of fallopian tube o C57.00 Malignant neoplasm of unspecified fallopian tube o C57.01 Malignant neoplasm of right fallopian tube o C57.02 Malignant neoplasm of left fallopian tube Concerns: Laterality

39 Coding Complexities Malignant neoplasm of prostate ICD-9 = 185 ICD-10 = C61

40 SRS/SBRT SRS-Stereotactic radiosurgery High dose delivery of radiation to a specific target- head/spine SBRT-Stereotactic body radiation therapy High doses of radiation using numerous fields to extra-cranial sites

41 SRS Delivery CPT Code Description Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt -60 based Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based Multifraction, SRS treatment delivery for cranial lesions, all spine SRS and all SBRT lesions.

42 SRS Treatment Management CPT Code Description SRS-Specific Guidelines Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session) (The same physician should not report both stereotactic radiosurgery services [ ] and radiation treatment management [77432 or 77435] for cranial lesions). For stereotactic body radiation therapy treatment use For use of a single fraction, complete course of therapy.

43 SBRT Delivery CPT Code Description Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions.

44 SBRT Treatment Management CPT Code Description SRBT-Specific Guidelines Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions (Do not report in conjunction with other treatment management codes ) Professional charge for treatment management performed by the radiation oncologist. This code can be reported only once for the entire course of treatment not per fraction. This will apply to all extracranial SBRT up to a maximum of 5 fractions. It will apply to all lesions treated during that entire course of treatment.

45 Example: SBRT Patient Flow Physician Visit & Facility Visit Physician Clinical Plan Special Treatment Procedure 99XXX-99XXX Or 99XXX-99XXX Imaging Simulation Calculations & Devices or or Stereotactic Treatment Delivery Clinical Treatment Plan Note justifying the use of this code Physician Treatment Management Documentation must include a management note Physics Services Special Physics Consult (77370) if ordered, performed, and documented Continuing Physics (77336)

46 Coding Complexities C34 Malignant neoplasm of bronchus or lung o Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure o tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0) Concerns: Additional coding and documentation Laterality

47 IORT Intraoperative Radiation Therapy o Radiation treatment occurring within an operative session o Breast Cancer o Single Dose o Delivery codes IORT, treatment delivery, X-ray, single treatment session IORT, treatment delivery, electrons, single treatment session o Management code Intraoperative radiation treatment management Physician Only Included not billable

48 Coding Complexities Anatomical Location ICD-9 ICD-10 Nipple Right C Nipple Left C Nipple Unspecified C Central Right C Central Left C Central Unspecified C Upper Inner Right Quadrant C Upper Inner Left Quadrant C Upper Inner Unspecified C Quadrant Lower Inner Right Quadrant C Lower Inner Left Quadrant C Lower Inner Unspecified C Quadrant Upper Outer Right Quadrant C Upper Outer Left Quadrant C Upper Outer Unspecified C Quadrant Lower Outer Right Quadrant C Lower Outer Left Quadrant C Lower Outer Unspecified Quadrant C50.519

49 Next Steps Auditing Monitoring Education Resources

50 Questions??