Practice Manager Insider

NCCN Offers Guidelines Annotated for CMS Demonstration Program; Updates Clinical Guidelines

Thirteen clinical guidelines annotated with CMS G-codes are available on the National Comprehensive Cancer Network (NCCN) website. These specially coded versions were designed to help speed determination of whether a given treatment adheres to the guidelines. The 2006 CMS Oncology Demonstration Program invites physicians to report to CMS about whether their patient management accords with either NCCN or ASCO guidelines.

The NCCN guidelines included in the 2006 CMS Oncology Demonstration Program, are for: breast cancer, chronic myelogenous leukemia, colon cancer, esophageal cancer, gastric cancer, head and neck cancers, multiple myeloma, non-Hodgkin’s lymphoma, non-small-cell lung cancer, ovarian cancer, pancreatic cancer, prostate cancer, rectal cancer, and small cell lung cancer.

Separately, the NCCN has released updates to 4 guidelines: NHL, Hodgkin’s disease/lymphoma, head and neck cancers, and gastric and esophageal cancers. These include recommendations regarding use of rituximab and thalidomide in lymphoma subtypes. A PET scan is now recommended for initial workup in the gastric and esophageal cancers guidelines.

Interview on 2006 Revisions to CPT Codes

The 2006 American Medical Association revisions to Current Procedural Terminology (CPT) codes will significantly impact the work of practice managers in the approaching year. Practice Manager Insider interviewed editorial board member, Patricia Falconer, MBA, president of Health Options, regarding exactly how oncology practices will be affected by the 2006 CPT revisions.

Listen to an audio recording of the interview here.

Codemistress Interviewed on 2006 HCPCS

The changes in the recently released 2006 Healthcare Common Procedure Coding System (HCPCS), which go into effect January 1, 2006, with no grace period, will have a significant effect on coding procedures for oncology practice managers. Practice Manager Insider interviewed editorial board member, Roberta “Bobbi” Buell, MBA, a private healthcare consultant and author of the coding newsletter, “Codemistress Comments” regarding the impact of these changes.

Listen to an audio recording of the interview here.

Community Oncology Alliance Supports Chemotherapy Demonstration Project

The Community Oncology Alliance (COA) announced its support for the 2005 Chemotherapy Demonstration Project and requested the project be extended to run through 2006. In the 2005 Chemotherapy Demonstration Project, initiated by the Centers for Medicare & Medicaid Services (CMS), practitioners assessed three issues associated with chemotherapy: controlling pain, minimizing nausea, and reducing fatigue. From these assessments, CMS will be able to modify treatment options and enhance symptom management. COA president Leonard Kalman, MD, states, “The Chemotherapy Demonstration Project is the necessary bridge created by CMS while the Congress and CMS work towards a permanent solution for oncology reimbursement.”  Under the 2005 project, practices qualify for an additional payment of $130 per encounter if they report to Medicare on all three factors. Practitioners self enroll in the project by billing with CMS designated codes.