Oncology practices often spend December handling year-end financial reports and juggling holiday time off requests. However, one thing that should never fall by the wayside is getting ready for the big changes that take effect when the calendar turns to the new year.
To prepare for changes set to take effect on January 1, 2024, and to verify implementation of other changes that took place in 2023, consider taking the following “quiz” and reviewing the answers.
Chemotherapy Coding Changes
True or False: As of Jan. 1, practices can report an add-on code to reflect hyperthermic intraperitoneal chemotherapy (HIPEC) that takes place along with another surgical procedure.
The answer is true because the Current Procedural Terminology (CPT) 2024 code set includes two new codes describing HIPEC:
+96547 (Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure))
+96548 (… each additional 30 minutes (List separately in addition to code for primary procedure))
The difference between the two add-on codes involves the time that the provider spends performing the HIPEC procedure. The practice should report +96547 for the first hour of HIPEC and can bill units of +96548 for every 30-minute period thereafter. Check payer policies before reporting these services to determine whether insurers impose limits on how many units of +96548 can be billed.
In addition, certain insurers may dictate which primary codes can be reported along with the HIPEC codes. Because these are both considered add-on codes, a primary surgery must be reported first, such as a tumor excision procedure in the intraperitoneal region.
Shared Savings Adjustments
True or False: In 2024, practices will benefit from a higher risk adjustment factor (RAF) linked to the complexity of a protein calorie malnutrition diagnosis.
The answer is false because the RAF for this diagnosis will actually be lower in 2024. This is due to Medicare Advantage’s (MA’s) discontinuation of the protein calorie malnutrition diagnosis being linked to a hierarchical condition category (HCC).
On Jan. 1, 2024, CMS will start transitioning from HCC Version 24 to HCC Version 28, which will reduce the shared savings calculations for nearly 2,300 ICD-10-CM codes. This could lead to lower payments for certain diagnoses, since the MA plans may no longer provide practices with payments that have been tied to complex conditions.
Family History Considerations
True or false: If a patient’s father had colon polyps, that should be added to the medical record, but there’s no way to include it on the claim.
The answer is false. There is now a way to include that information on the claim. The 2024 ICD-10-CM code set includes several new diagnoses that describe a family history of colon polyps. If the provider documents this history, then the coder should consider adding one of the new diagnoses to the claim:
Z83.71 (Family history of colon polyps)
Z83.711 (Family history of hyperplastic colon polyps)
Z83.718 (Other family history of colon polyps)
Z83.719 (Family history of colon polyps, unspecified)
These codes are not typically required on medical claims, but they can provide payers with additional information about how complex the patient’s condition is. In the case of a screening test for colon polyps, using a code like Z83.71 would tell the payer why the provider ordered such a test for patients who may not meet the criteria otherwise. The added risk that the family history codes describe may also increase the level of medical decision-making, which – in some cases – may be tied to a higher-level evaluation and management code.
Time Threshold Change for Nursing Facility Visits
True or false: If an oncologist sees a patient for a subsequent nursing facility visit with total time lasting 10 minutes in 2024, the oncologist can report 99307.
This answer is false because the time thresholds are changing on Jan. 1, 2024. When the calendar turns to the new year, the encounter must meet or exceed 20 minutes to report 99307 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded).
Keep in mind that the 20-minute threshold refers to “total time” on the date of the encounter, which may not all be spent with the patient. It could include time at the patient’s bedside, as well as time reviewing charts or talking with other providers, for instance.
