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Radiation Oncology Billing and Coding Q&A – Part 4

Radiation Oncology Billing and Coding Q&A featured by SROA

By: Tammy McCausland


Teri Bedard, Executive Director, Client & Corporate Resources with Revenue Cycle Coding Strategies, discusses new technologies. This content originally appeared in Radiation Oncology News for Administrators, Vol. 31 No. 3.


Q: How are new technologies going to impact radiation oncology reimbursement?

A: With newer technology, codes will be considered outdated or archaic. The technology will always out-advance the coding and the regulations that we have because a lot of times the AMA and CMS are not going to change their guidelines just because a new technology comes out. They want to see how it works, how it’s being used. Sometimes with new technology we have to use existing codes and figure out how we fit those into the workplan or the work process.

The MR-linac and RefleXion’s BgRT are dramatic shifts and changes to treating patients. Normally, we treat the patient, we plan their treatment, and we know that the tumor is probably going to respond over time, but we may not be able to see that change in that patient as soon. Now, with the technology of MR and some of the other imaging tools, we can see it almost in real time. Now, there is the possibility to bill for additional planning codes. These are high-volume, high-revenue codes, and that’s a huge shift. Some of them have a high price tag, and there isn’t that additional code yet available to make up for the spending required to purchase this technology. We’re still using the same codes because they’re so general in some ways.


Q: Is that a barrier for a treatment center?

A: It is, and that’s one of the things that a lot of vendors are trying to address and show what the possible return on investment is. It really depends upon how many patients the center is going to actually treat, so it can be a barrier. The price tag and knowing that, right now, we don’t have additional codes or other additional revenue that could be coming in to compensate for that price tag are going to be concerns.


Q: How does proton therapy fit into the picture?

A: There are some difficulties with proton, and that’s one of the reasons proton also got locked into the RO model. There’s been an explosion with proton. Since conventional therapies work for diagnoses like prostate cancer, payers push back saying, “There are no studies that show that proton is better than other conventional therapy.” For pediatric patients the studies do show proton is better for them. A lot of proton is under clinical trials in order to get paid. One of the bigger concerns is that building a proton center is really expensive because it’s a much different buildout than what we normally use for radiation oncology. It’s difficult to make up multi-millions of dollars and secure that volume of patients to come through.


Q: Do you have any final thoughts on radiation oncology coding and billing?

A: As the technology changes, we’re looking at more remote patient monitoring. A lot of technologies out there are revamping some of those codes. How do we use them in radiation oncology? There are some limitations because of how we bill for our patients already.

We’ve seen changes from the outpatient standpoint of the evaluation and management visits. Those are the consult visits. I think we’re going to see some more changes coming up in the next couple of years to other evaluation and management visit codes, whether it’s inpatient, observation or emergency room. I don’t anticipate huge things for radiation oncology-specific codes, unless they’re trying to match some of the new technology with some additional codes.

What new technologies is your cancer center investing in?


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Related Content: Radiation Oncology News for Administrators, Vol. 31 No. 3

Society For Radiation Oncology Administrators (SROA)
Radiation Oncology News for Administrators, Vol. 31 No. 3


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