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.

Detailed Information on 2006 Demonstration Project

In late December, CMS announced that it would implement the Medicare Oncology Demonstration Project for 2006. Its purpose is to identify and assess certain oncology services provided in office-based practices that affect outcomes in Medicare patients. CMS has developed two publications that detail information on this year’s Demonstration Project. The first, SE0589, covers information on Medicare policy and claims processing as it applies to the Demonstration Project. The second, SE0588, provides guidelines on documentation and coding.

2006 Oncology Demonstration Codes Released

The Centers for Medicare & Medicaid Services (CMS) is making extensive revisions to the 2005 Oncology Demonstration Project for the coming year. The 2005 Oncology Demonstration Project centered on the submission of G-codes corresponding to nurse assessment of side effects from chemotherapy. However, for the 2006 Oncology Demonstration Project reimbursement will be per service during an office visit not solely for chemotherapy treatment, and the G-codes will be used to record how well oncologists follow evidence-based practice guidelines. The American Society of Clinical Oncology has listed out the newly revised 2006 G-codes that are essential for oncologists to learn so they may properly code and receive full reimbursement under the 2006 Oncology Demonstration Project.  In addition, ASCO has assembled a spreadsheet so practice managers can calculate the effect of the 2006 Demonstration Project on their office.