Brittany Check

Overview Patient care

Commission on Cancer standardsIntegrative medicineConcurrent chemotherapy/radiation patients

Quality improvementQuality reporting system

New methods and technologiesIntracoronary brachytherapyProne breast protocolCBCT planning for bone metastases

Coding updates

Patient Care

Commission on Cancer standardsPatient-centered standards

○ Patient navigation○ Psychosocial distress○ Survivorship

Patient Navigation

Reduce barriers for patientsEducateForm partnerships in communityCoordinate appointmentsPromote self-advocacyInform about trials

Assess and form process to meet specific needs of patients

Psychosocial Distress NCCN distress thermometer

Form process for screening patients

Survivorship

Information for patientDiagnostic tests and resultsCharacteristic of diseaseProcedure datesTreatment summaries

ASCO templates for breast and colorectal

Patient Care

Integrative medicineMay help empower patients, reduce

symptoms, and promote wellnessEvaluate safety vs. efficacy

Integrative Medicine Yoga Massage

Stress

AcupunctureNausea/VomitingXerostomia

Herbs/supplementsNo antioxidantswww.mskcc.org/aboutherbs

Patient Care

Concurrent chemotherapy and radiation patientsCommon for patients with cancer of:

○ GastrointestinaI system○ Head/neck○ Cervical/GYN○ Lung

Chemo/Radiation Patients Most agents used concurrently are

radiosensitizingInhibit repairShift phase in cell cycleIncrease radiation caused damage

Decrease occurrence of distant metastases

Chemo/Radiation Patients Common concurrent chemotherapy

agents:5-FUXeloda (oral 5-FU)CarboplatinGemcitabineCisplatinMitomycinCetuximab (Erbitux)

Chemo/Radiation Patients

Common side effects:

Not combined if agent and radiation cause toxicity to same organ

Chemo/Radiation Patients Extra monitoring Early intervention Dialog for bowel habits Skin care from beginning of treatment Process for getting fluids Icon in Aria for combined

chemo/radiation patients

Quality Improvement

Quality reporting system

Quality Improvement

Improving efficiency5S – sort through, set in order, shine,

standardize, sustainTransportation collaborationIncrease staffing on high-volume machinesPatients asked to arrive 10-15 minutes early

New Methods and Technologies Intracoronary brachytherapy

New Methods and Technologies Prone breast protocol

Used for large pendulous breastsAdvantages

○ Sparing to heart and lungs○ Dose homogeneity○ Reduced respiratory motion

Disadvantages○ Reproducibility

Prone Breast Treatment

Comparison of supine vs. prone for 6 patientsDmax 3.6% lower for prone plans

Supine Prone

Left lung mean 11.4% 1.1%

Left lung maximum 101.6% 56.9%

Heart mean 5.5% 2.7%

Heart maximum 101.6% 85.4%

*of prescribed dose

New Methods and Technologies CBCT planning for bone metastases

Coding Updates

Revenue Cycle2014 Medicare Physician Fee Schedule and

Hospital Outpatient Prospective Payment proposed rules

Accurate as of September 23, 2013. Final rules to be determined around November 1, 2013

Coding Updates

Stereotactic treatmentDiscontinue differentiation between robotic

and non-robotic stereotactic procedures○ Assume there is some robotic element to all

radiosurgery proceduresDeletion of existing G-codes

○ G0173, G0251, G0339, G0340Use 77372 for SRSUse 77373 for SBRT

Coding Updates

PackagingBased on category of service

○ Integral, ancillary, supportive, dependent, adjunctive items

Change ancillary services with status indicator X to Q1○ Q1: Simulations, treatments devices,

treatment planning

Coding Updates

PackagingQ1 services packaged when used with S, T,

or V services○ S: Treatment delivery○ S,T, or V code paid

Q1 services packaged when used together○ Highest reimbursed Q1 paid in quantity 1

Coding Updates

SupervisionAll therapeutic services in hospitals require

direct supervision○ “Direct supervision in the office setting means the physician must be

present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.”

Medical oncologist is not sufficient for radiation therapy procedures according to Revenue Cycle

Enforced in 2014

Coding Updates

Clinic visitsGXXXC code for all levels of clinic visits

○ Discontinue 99201-99205 and 99211-99215○ Does not distinguish between new and

established patients

Coding Updates

Common errorsPhysician orders and medical necessity

not locatedIncomplete or missing documentationIncorrect dates of service used for billingIncorrect CPT codesMissing or late signaturesBilling under incorrect physicianBilling under incorrect location

Coding Updates

Recommendations to avoid mistakesInternal compliance planDaily charge and documentation reviewDaily interface verification auditsInternal audits

Coding Updates ICD-10-CM effective October 1, 2014

Category

Numeric or Alpha (E or V) Numeric

Category, Anatomic Site,

Severity

Alpha(except U) Numeric

Numeric or Alpha (except U)

Category Category, Anatomic Site,

Severity

Extension

Coding Updates

ICD-9-CM to ICD-10-CM 12 codes can be listed on claimsCodes can contain placeholder “X”V and E codes incorporated into main

classification○ Factor influencing, external causes, etc.