April 30, 2009

ACR Radiology Coding Source™ March-April 2009 Q and A

Q: A patient with Kaposi’s sarcoma has an electron plan for nine separate areas. Should the isodose plan code be reported once or per area treated?

A: If the treatment team believes an isodose plan is required, it is appropriately coded as 77321, Special teletherapy port plan, particles, hemibody, total body. To correctly report 77321, a separate electron distribution must be performed for each volume. Code 77321 should be reported only once even though multiple plans may be created. 

In the absence of an isodose plan, code 77300, Basic radiation dosimetry calculation, central axis depth dose calculation, TDF [time, dose, fractionation parameter], NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician, could be reported for each lesion (if treated separately). This is done to insure that the monitor units used are correct for the prescription dose for each lesion. Most electron fields with a relatively simple geometry can be adequately treated with just the 77300 calculation. 

Q: We currently report on Measure #145 – Exposure Time Reported for Procedures Using Fluoroscopy as part of the Physician Quality Reporting Initiative (PQRI) program. However, we have noticed there are some codes listed in the denominator for this measure that do not include fluoroscopy. How should these nonfluoroscopy codes be reported? 

A: The Centers for Medicare and Medicaid Services (CMS) has issued clarification on the Physician Quality Reporting Initiative (PQRI) Measure #145, Exposure Time Reported for Procedures Using Fluoroscopy. CMS and the measure developer recommend that you do not change how you have been reporting Measure #145 and that you continue to report in the manner in which you have been reporting for the 2009 reporting period. 

If you have been reporting the quality-data code (QDC) 6045F with the 8P modifier (action not performed, reason not otherwise specified) for any of the 22 non-fluoroscopy procedures, you should continue to report the 8P modifier for those procedures. If you have NOT reported any QDC codes for the 22 non-fluoroscopy procedures, DO NOT START reporting QDCs codes now. CMS will calculate two different reporting rates for each individual National Provider Identifier (NPI) for this measure and will use the most favorable reporting rate. The performance rate will exclude the 22 non-fluoroscopy codes. 

The specifications provided to CMS inadvertently included 22 CPT codes for non-fluoroscopy radiology procedures in the denominator. The 22 non-fluoroscopy codes identified are: 36597, 64510, 64520, 64622, 64626, 74400, 74410, 74415, 74420, 75820, 75822, 76100, 76101, 76102, 76150, 77031, 77053, 77054, 77071, G0259, G0260, and G0365. Because the PQRI measure specifications are final as posted on the CMS PQRI Web site, CMS is providing an analytic fix for this measure so as not to disadvantage eligible professionals. 

This information was posted on the CMS PQRI FAQ Web site on March 31, 2009, as FAQ #9675. Please contact P4Pquestions@acr.org with questions.