As advancements in oncology continue to evolve, so too do the coding practices that ensure proper billing and reimbursement for cancer care. Keeping up-to-date with the latest CPT (Current Procedural Terminology) codes and modifiers is crucial for revenue cycle management (RCM) companies working with oncology practices. Accurate coding not only ensures compliance but also maximizes revenue by reducing claim denials and payment delays. This article highlights the newest CPT codes and modifiers in oncology that RCM companies need to be aware of.

1. New and Revised CPT Codes in Oncology

The American Medical Association (AMA) updates CPT codes annually, reflecting new technologies and practices in medical care. Here are some of the key additions and changes relevant to oncology:

Immunotherapy and Targeted Therapy

• CPT Code 96446: This new code covers the administration of chemotherapy via prolonged infusion, lasting more than eight hours, requiring the use of a portable or implantable pump. This code is particularly relevant for oncology practices administering extended chemotherapy treatments.

• CPT Code 96377: This code has been introduced for the application of on-body injectors (e.g., Neulasta Onpro). These devices are increasingly used in oncology to deliver medications subcutaneously over a period of time.

Radiation Oncology

• CPT Code 77387: This new code covers the delivery of stereotactic body radiation therapy (SBRT) treatment, per treatment session, including image guidance (IGRT). SBRT is a precise, high-dose radiation therapy used to treat small tumors.

• CPT Code 77385: This updated code covers intensity-modulated radiation therapy (IMRT) delivery, including treatment planning and dose calculations.

Genetic and Genomic Testing

• CPT Code 81445: This code applies to the analysis of gene expression profiles in tumors to determine the best course of treatment. It reflects the growing importance of personalized medicine in oncology.

• CPT Code 81450: This new code covers comprehensive genomic profiling, which is crucial for identifying mutations and informing targeted therapies.

2. New Modifiers in Oncology

Modifiers provide additional information about the services rendered and are essential for accurate coding and billing. Here are some recent updates in oncology-related modifiers:

Modifier -JZ

• Modifier -JZ: This new modifier is used to indicate that a zero-waste amount of a drug was discarded. This is important for billing purposes, as it helps clarify that no portion of the drug was unused and wasted, which can impact reimbursement.

Modifier -JW

• Modifier -JW: While not new, this modifier remains crucial for oncology practices. It is used to report the amount of drug discarded and eligible for payment under Medicare’s discarded drug policy. Accurate use of this modifier ensures proper reimbursement for expensive oncology drugs.

Modifier -XE, -XP, -XS, -XU

• Modifiers -XE, -XP, -XS, -XU: These modifiers are used to define specific subsets of the -59 modifier (Distinct Procedural Service) which was introduced to reduce the likelihood of claim denials due to improper usage. Each modifier provides greater specificity:

• -XE: Separate Encounter, a service that is distinct because it occurred during a separate encounter.

• -XP: Separate Practitioner, a service that is distinct because it was performed by a different practitioner.

• -XS: Separate Structure, a service that is distinct because it was performed on a different organ/structure.

• -XU: Unusual Non-Overlapping Service, a service that is distinct because it does not overlap usual components of the main service.

Conclusion

Staying current with the latest CPT codes and modifiers is essential for RCM companies to ensure accurate billing and maximize revenue in oncology practices. The 2024 updates reflect significant advancements in treatment modalities and diagnostic technologies. By integrating these new codes and modifiers into their billing processes, oncology practices can enhance compliance, reduce claim denials, and ensure appropriate reimbursement for their services. As the field of oncology continues to evolve, keeping abreast of coding changes will remain a critical component of effective revenue cycle management.