Tumor excision codes get specific. Will surgical oncology practices take a reimbursement hit?
We’re starting to learn what new CPT codes we’ll be using come January 1, 2010. Coding News will keep you posted over the coming weeks, along with analysis from coding experts around the country so that you know what to expect for your practice’s bottom line.
CPT 2010 has created over a dozen tumor excision codes that require you to designate the tumor size. For instance, code 21930 represents a tumor excision of the soft tissue of the back or flank measuring less than 3 cm, while 21931 describes the same tumor but 3 cm or greater.
“Until these codes, there has never been a way to express the depth of removing a tumor or tumorous mass except with modifier 22 (Unusual procedural services),” says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net.
“In theory, the size of a tumor should fairly well reflect the depth and difficulty in terms of work that has to be done to remove the tumors,” Johnson says. “Payment received should be reflective of that work — more money for more work.”
Payment Changes? “It will be interesting to see how the RVUs stack up to the existing codes now that they are billed according to size,” comments Leslie Follebout, CPC, COSC, PCS, coding department supervisor with Peninsula Orthopedic Associates in Salisbury, Md.
Adapted from Part B Insider. Download your 2 FREE sample issues here.
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