Session 2
January 2015 Jean C. Russell, MS, RHIT [email protected] Richard Cooley, BA, CCS [email protected] Matthew H. Lawney, MSPT, MBA, CHC [email protected] 518-430-1144 2 Agenda • Changes 2015 • • • • • • • • Delivery Guidance Technical Professional Hospital vs. Free-standing Financial Impact Comprehensive APC Modifier 59 3 PFS 2015 Final Rule CPT revised the radiation therapy code set for CY 2015 following identification of some of the codes as potentially misvalued and the affected specialty society’s contention that the provision of radiation therapy could not be accurately reported under the existing code set The coding changes for CY 2015 involve significant changes in how radiation therapy services and associated image guidance are reported 4 Rad Onc Deleted Codes HCPCS 77305 77310 77315 77326 77327 77328 77403 77404 77406 77408 77409 77411 77413 77414 77416 77418 77421 0073T SVCDESC Teletx Isodose plan Simple Teletx Isodose plan Intermed Teletx Isodose plan Complex Brachytx Isodose Calc Simple Brachytx Isodose Calc Intermed Brachytx Isodose Calc Complex Rad Tx Single Area 6-10 MeV Rad Tx Single Area 11-19 MeV Rad Tx Single Area ≥ 20 MeV Rad Tx Two Areas 6-10 MeV Rad Tx Two Areas 11-19 MeV Rad Tx Two Areas ≥ 20 MeV Rad Tx Three+ Areas 6-10 MeV Rad Tx Three+ Areas 11-19MeV Rad Tx Three+ Areas ≥ 20MeV IMRT Treatment Delivery Stereoscopic Local Target Vol Compnstr IMRT Tx Del 3+ Fields SI 10/2014 X X X X X X S S S S S S S S S S N S SI 2015 D D D D D D D D D D D D D D D D D D 0197T Intrafraction track motion N G0173 G0251 Stereo Radoisurgery Complete Lin Acc Stereotactic Radiosurg B B D D D 5 Rad Onc New Codes TOTHCPCS 77306 77307 77316 77317 77318 77385 77386 77387 G6001 G6002 G6003 G6004 G6005 G6006 G6007 G6008 G6009 G6010 G6011 G6012 G6013 G6014 G6015 G6016 G6017 SVCDESC Teletx isodose plan; simple 1 or 2 unmodified ports Teletx isodose plan; complex multiple treatment areas Brachyt isodose plan; simple calculation made from 1 to 4 sources Brachyt isodose plan; intermediate calc made from 5 to 10 sources Brachyt isodose plan; complex calculation made from over 10 sources IMRT Treatment Delivery Simple IMRT Treatment Delivery Complex Guide localization target volume radiation treatment delivery Echo guidance radiotherapy Stereoscopic x-ray guidance Rad Sing Tx up to 5mev Rad Sing Tx 6-10mev Rad Sing Tx 11-19mev Rad Sing Tx 20mev or more Rad Two Tx up to 5mev Rad Two Tx 6-10mev Rad Two Tx 11-19mev Rad Two Tx 20mev or more Rad Three or More Tx up to 5mev Rad Three or More Tx 6-10mev Rad Three or More Tx 11-19mev Rad Three or More Tx 20mev or more IMRT Radiation tx delivery IMRT Delivery comp Intrafraction track motion SI 2015 S S S S S S S N B B B B B B B B B B B B B B B B B 6 Unusual Mapping Unusual in that some professional are using G- codes whereas technical are using AMA CPT codes Professional G-code mapping available in the 2015 PFS Final Rule- “Table 27” Since the code set has changed and some of the CY 2014 codes are being deleted, we are creating G-codes as necessary to allow practitioners to continue to report services to CMS in CY 2015 as they did in CY 2014 and for payments to be made in the same way All payment policies applicable to the CY 2014 CPT codes will apply to the replacement G-codes 7 Tech/Prof Change Mapping HCPCS 77305 77310 77315 77326 77327 77328 77402 SVCDESC Teletx Isodose plan Simple Teletx Isodose plan Intermed Teletx Isodose plan Complex Brachytx Isodose Calc Simple Brachytx Isodose Calc Intermed Brachytx Isodose Calc Complex Rad Tx delivery >=1 MeV Simple SI 2015 D D D D D D S 77403 Rad Tx Single Area 6-10 MeV D 77404 Rad Tx Single Area 11-19 MeV D 77406 Rad Tx Single Area ≥ 20 MeV D 77407 Rad Tx delivery >1 MeV Intermediate S 77408 Rad Tx Two Areas 6-10 MeV D 77409 Rad Tx Two Areas 11-19 MeV D comments to report use 77306 to report see 77306 and 77307 to report use 77307 to report use 77316 to report use 77317 to report use 77318 Change description for 2015- for technical reporting continue to use 77402- for professional reporting use G6003 for technical reporting use 77402- for professional reporting use G6004 for technical reporting use 77402- for professional reporting use G6005 for technical reporting use 77402- for professional reporting use G6006 Change description for 2015- for technical reporting continue to use 77407- for professional reporting use G6007 for technical reporting use 77407- for professional reporting use G6008 for technical reporting use 77407- for professional reporting use G6009 8 Tech/Prof Change Mapping Cont. HCPCS SVCDESC 77411 Rad Tx Two Areas ≥ 20 MeV SI 2015 D 77412 Rad Tx delivery >1 MeV Complex S 77413 Rad Tx Three+ Areas 6-10 MeV D 77414 Rad Tx Three+ Areas 11-19MeV D 77416 Rad Tx Three+ Areas ≥ 20MeV D 77418 IMRT Treatment Delivery D 77421 Stereoscopic Local Target Vol D 0197T Intrafraction track motion D 0073T Compnstr IMRT Tx Del 3+ Fields D G0173 G0251 Stereo Radoisurgery Complete Lin Acc Stereotactic Radiosurg D D comments for technical reporting use 77407- for professional reporting use G6010 Change description for 2015- for technical reporting continue to use 77412- for professional reporting use G6011 for technical reporting use 77412- for professional reporting use G6012 for technical reporting use 77412- for professional reporting use G6013 for technical reporting use 77412- for professional reporting use G6014 for technical reporting see 77385 and 77386- for professional reporting use G6015 for technical reporting use 77387- for professional reporting use G6002 for technical reporting use 77387- for professional reporting use G6001 for technical reporting use 77385- for professional reporting use G6016 to report use 77372 to report use 77373 9 Therapy Delivery 10 Definition Changes 77401- Radiation treatment delivery, superficial and/or ortho voltage, per day 77402- Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or opposed blocks up to 5 MeV >= 1MeV simple (note CPT errata correction for >=) 77407 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks up to 5 MeV >= 1MeV; intermediate 77412 Radiation treatment delivery, 3 or more treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam up to 5 MeV >= 1MeV complex 11 77402 Mapping HCPCS SVCDESC 77402 Rad Tx delivery >=1 MeV Simple 77403 Rad Tx Single Area 6-10 MeV SI 2015 comments S Change description for 2015- for technical reporting continue to use 77402- for professional reporting use G6003 D for technical reporting use 77402- for professional reporting use G6004 77404 Rad Tx Single Area 11-19 MeV D for technical reporting use 77402- for professional reporting use G6005 77406 Rad Tx Single Area ≥ 20 MeV D for technical reporting use 77402- for professional reporting use G6006 No Professional component for Hospital billing G-codes and 77402 have PC/TC indicator of 3= Technical only 12 77407 Mapping HCPCS SVCDESC 77407 Rad Tx delivery >1 MeV Intermediate SI 2015 S 77408 Rad Tx Two Areas 6-10 MeV D comments Change description for 2015- for technical reporting continue to use 77407- for professional reporting use G6007 for technical reporting use 77407- for professional reporting use G6008 77409 Rad Tx Two Areas 11-19 MeV D for technical reporting use 77407- for professional reporting use G6009 77411 for technical reporting use 77407- for professional reporting use G6010 Rad Tx Two Areas ≥ 20 MeV D No Professional component for Hospital billing G-codes and 77407 have PC/TC indicator of 3= Technical only 13 77412 Mapping HCPCS SVCDESC 77412 Rad Tx delivery >1 MeV Complex SI 2015 S comments Change description for 2015- for technical reporting continue to use 77412- for professional reporting use G6011 for technical reporting use 77412- for professional reporting use G6012 77413 Rad Tx Three+ Areas 6-10 MeV D 77414 Rad Tx Three+ Areas 1119MeV D for technical reporting use 77412- for professional reporting use G6013 77416 Rad Tx Three+ Areas ≥ 20MeV D for technical reporting use 77412- for professional reporting use G6014 No Professional component for Hospital billing G-codes and 77412 have PC/TC indicator of 3= Technical only 14 Billing for Free-Standing 2014 77402 77403 77404 77406 77407 77408 77409 77411 77412 77413 77414 77416 Add B Status Indicator S D D D S D D D S D D D PC/TC Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only Tech Only 2015 G6003 G6004 G6005 G6006 G6007 G6008 G6009 G6010 G6011 G6012 G6013 G6014 Add B Status Indicator B B B B B B B B B B B B PC/TC 2014 Short Description Tech Only Rad Tx delivery >=5 MeV Simple Tech Only Rad Tx Single Area 6-10 MeV Tech Only Rad Tx Single Area 11-19 MeV Tech Only Rad Tx Single Area ≥ 20 MeV Tech Only Rad Tx delivery >5 MeV Intermediate Tech Only Rad Tx Two Areas 6-10 MeV Tech Only Rad Tx Two Areas 11-19 MeV Tech Only Rad Tx Two Areas ≥ 20 MeV Tech Only Rad Tx delivery >5 MeV Complex Tech Only Rad Tx Three+ Areas 6-10 MeV Tech Only Rad Tx Three+ Areas 11-19MeV Tech Only Rad Tx Three+ Areas ≥ 20MeV Carrier 13282 Locality 99 POS 22 $153.19 $118.35 $132.56 $131.88 $243.53 $164.02 $181.61 $181.61 $260.44 $215.45 $242.85 $242.51 15 Definitions Professional G-codes have hung onto the 2014 definitions, while CPT codes have 2015 definitions HCPCS 2014 Description 77402/ Rad Tx delivery >=5 G6003 MeV Simple SI 2015 2015 Description S Radiation treatment delivery >= 1MeV; simple 77403/ Rad Tx Single Area 6-10 D G6004 MeV Radiation treatment delivery >= 1MeV; simple 77404/ Rad Tx Single Area 11-19 D G6005 MeV Radiation treatment delivery >= 1MeV; simple 77406/ Rad Tx Single Area ≥ 20 D G6006 MeV Radiation treatment delivery >= 1MeV; simple 16 77418 Mapping (IMRT) 77418- Intensity modulated treatment delivery, single or multiple field/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session Technical- PC/TC indicator = 3 (Technical only) 77385- intensity modulated radiation treatment delivery (IMRT) includes guidance and tracking, when performed; simple 77386- ; complex Professional- Free-standing G6015 Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session 17 Guidance 18 Guidance Changes IGRT (Image Guided Radiation Therapy) codes 77421, 0197T, 76950 were made invalid and replaced with 77387 77014 was not changed HCPCS SUBDEPT INVALID SVCDESC 77421 Stereoscopic Local RADTHER INVALID Target Vol D 0197T Intrafraction track RADTHER INVALID motion D 76950 US 77014 CT US Guide place Rad Tx INVALID Fields CT Guide place Rad Tx Fields SI 2015 comments D Valid through 12/31/2014- for technical reporting use 77387- for professional reporting use G6002 Valid through 12/31/2014- for technical reporting use 77387- for professional reporting use G6017 Valid through 12/31/2014- for technical reporting use 77387- for professional reporting use G6001 N 1/1/2015- do not report with IGRT 19 Guided Payment Carrier 13282 Locality 99 HCPCS SVCDESC Professional POS 22 Techincal 77421 Stereoscopic Local Target G6002 $71.34 77387 packaged Vol 0197T Intrafraction track motion G6001 $49.66 77387 packaged US Guide place Rad Tx $49.66 76950 Fields G6001 77387 packaged 20 Split Billing 77387-G6002 HCPCS Mod G6002 Short Description Stereoscopic x-ray guidance G6002 26 Stereoscopic x-ray guidance G6002 TC Stereoscopic x-ray guidance PC TC 1 1 1 professional and technical component professional and technical component professional and technical component Medicare Professional- report G6002-26 POS 22 Technical- report 77387 (refer to chart on page 440 of CPT manual for packaging rules) Commercial payers Check your contract Bill G-codes for payers that reimburse on PFS Bill 77387 for payers that reimburse on APC 21 Billing IMRT with IGRT 77385 Intensity modulated rad tx (IMRT), simple 77387 Image guided rad tx (IGRT) Medicare technical Bill 77385 (77387 is packaged technically with 77385 (chart page 440 AMA CPT Manual)) No professional side to 77385 Medicare professional Professional- report G6002-26 POS 22 (77385 is technical only, so no professional side) 22 77387 Guidance Bundling 23 Professional Rules 2015 Follow all coding guidelines from 2014 for 2015 …we are creating G-codes as necessary to allow practitioners to continue to report services to CMS in CY 2015 as they did in CY 2014 and for payments to be made in the same way All payment policies applicable to the CY 2014 CPT codes will apply to the replacement G-codes PFS Final Rule 24 Can’t Map Prof to Tech If the hospital captures 77387 in ARIA or MOSAIQ [ordering systems], there is no way for the physician billing company to know which IGRT service is to be billed MBR Radiation Oncology Billing Company 2015 Tech 2014 tech 2015 Prof SVCDESC 77387 77421 G6002 Stereoscopic Local Target Vol 77387 0197T G6001 Intrafraction track motion 77387 76950 G6001 US Guide place Rad Tx Fields 25 Teletherapy 26 77310 Mapping 77310 is valid through 12/31/2014- to report see 77306 and 77307- technical and professional 77310- Teletherapy, isodose plan (whether hand or computer calculated); intermediate (3 or more treatment ports directed to a single area of interest) 77306- Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) 77307- complex (multiple treatment areas, tangential ports, the use of wedges, blocking rotational beam, or special beam considerations), includes basic dosimetry calculation(s) 27 77306-77307 Split Billing HCPCS 77306 77306 77306 77307 77307 77307 Mod Short Description Telethx isodose plan simple 26 TC Telethx isodose plan simple Telethx isodose plan simple Telethx isodose plan cplx 26 TC Telethx isodose plan cplx Telethx isodose plan cplx PC TC 1 1 1 1 1 1 Technical- bill 77306 or 77307 Professional- bill with modifier 26 and POS 22 professional and technical component professional and technical component professional and technical component professional and technical component professional and technical component professional and technical component 28 Financial Impact 29 Postponing Valuation Changes until 2016 There is substantial work to be done to assure the new valuations for these codes accurately reflect the coding changes Accordingly we are delaying the use of the revised radiation therapy code set until CY 2016 when we will be able to include proposals in the proposed rule for their valuation We are maintaining the inputs for radiation therapy codes at the CY 2014 levels PFS Final Rule 2015 30 Impact Study Essentially Neutral for 2014-2015 2014 Professional Technical Sum 2015 % change $351,464.69 $356,912.05 1.55% $1,978,436.23 $1,965,938.31 -0.63% $2,329,900.92 $2,322,850.36 -0.30% There may be significant impact for 2015-2016 31 C-APC 32 Comprehensive APCs Clinical Family BREAS RADTX HCPCS 77424 77425 77371 77372 Description Breast Surgery Radiation Oncology SUBDEPT RADTHER RADTHER RADTHER RADTHER C-APC APC Title Level IV Breast and Skin 648 Surgery 67 Single Session Cranial SRS SVCDESC Io rad tx delivery by x-ray Io rad tx deliver by elctrns Srsmultisource Srslinear Based APC 648 648 67 67 SI 10/2014 S S S S 2015 Payment $7,461.40 $9,765.40 SI 2015 J1 J1 J1 J1 33 59 Modifier XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure, XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service. 34 Questions and Discussion 35 Contact Us Richard Cooley Phone: Email: 518-430-1144 [email protected] Jean Russell Phone: Email: 518-369-4986 [email protected] Matt Lawney Phone: Email: 845-642-6462 [email protected] 36 http://www.EpochHealth.com/ 37 CPT® Current Procedural Terminology (CPT®) Copyright 2012 American Medical Association All Rights Reserved Registered trademark of the AMA 38 Disclaimer Information and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary.
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