The Centers for Medicare and Medicaid Services (CMS) continue to collect data related to oncology services to determine appropriate payment rates in private practices and in hospital outpatient departments. The proposed -10.1 percent cut in physician services was reversed by Congress, giving physicians a temporary 0.5 percent increase in the conversion factor to $38.087 through June 30. The payment rate will revert back to the original -10.1 as of July 1, 2008 if further action is not taken.

New Infusion Codes. Effective January 2008, three new codes have been added for therapeutic and prophylaxis infusion. These codes are as follows:

• 90769 – Subcutaneous infusion for therapy or prophylaxis initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site. (16 minutes or more)
• 90770 – Each additional hour
• 90771 – Subcutaneous infusions additional pump set up with establishment of new subcutaneous infusion site. (once per encounter)

Revised Codes: 90760 – IV infusion hydration, initial hour now requires at least 31 minutes. Documentation of start and stop times becomes even more important in determining whether it is correct to use this code. If the infusion for hydration is less than 31 minutes, you are required to use the injection code.

Modifiers. Three new modifiers are now required when reporting claims for erythropoiesis stimulating agents (ESA’s) J0881, darbepoetin alfa, 1 mcg, and J0885, epoetin alfa: 1000 units. 1) EA-ESA, anemia, chemo-induced; 2) EB-ESA, anemia, radio-induced; and 3) EC-ESA, anemia, non-chemo/radio induced. In addition to the modifier, all claims require reporting of either the most recent hematocrit or hemoglobin levels.

Two additional modifier changes relate to clinical trials: Q0 – Replaces QA and QR for investigational clinical services provides during a research study; Q1 – Replaces the QV modifier for routine items or services provided in a Medicare Qualifying clinical trial on facility claims.

For 2008 in the practice setting, reimbursement for pharmaceuticals remains at the Average Sales Price (ASP) +6 percent.

Click here to view a table (from the upcoming March/April 2008 Oncology Issues) that demonstrates drug reimbursement for the first quarter of 2008 in the private practice setting, the current hospital outpatient department at ASP +5 percent, and the proposed ASP +3 percent for hospitals in 2009.

Hospital outpatient department reimbursement was reduced to ASP +5 percent for 2008. CMS has proposed to use 2008 as a transition year for hospital outpatient departments and initiate ASP +3 percent in 2009. For 2008, the hospital outpatient department packaging threshold for drugs not paid separately was raised to $60.

Medicare continues to reimburse pre-administration services for IVIG using code G0332. In addition, anti-emetics are reimbursed separately and exempt from the hospital outpatient packaging rule.

• Avastin. The Food and Drug Administration (FDA) gave accelerated approval to use Avastin (bevacizumab) in combination with paclitaxel chemotherapy in patients with metastatic HER2-negative breast cancer who haven't had any chemo yet. Accelerated approval can be changed to full approval after Genentech submits data from two additional Avastin breast cancer trials. According to an announcement from Genentech, the approval is based on a Phase III study (E2100) that showed that Avastin in combination with paclitaxel chemotherapy resulted in a 52 percent reduction in the risk of disease progression or death compared to those treated with paclitaxel alone and a doubling in progression-free survival (PFS) (based on a hazard ratio of 0.48; p<0.0001). Avastin is already approved in the U.S. for treating lung and colon cancer. Through a partnership with Genentech, Swiss drug maker Roche markets the drug in Europe, where it had previously been approved as a breast-cancer treatment.
• Ixempra. CMS has assigned a specific C-code, C9240, to Ixempra (ixabepilone) effective date of service January 1, 2008. Billing for Ixempra should be done by total dose, in 1-mg billing units.
• Leukine. Bayer Healthcare Pharmaceuticals and the FDA have informed healthcare professionals of the market withdrawal of the current liquid formulation of Leukine, a growth factor that helps fight infection and disease in appropriate patients by enhancing immune cell function. The product was withdrawn because of an upward trend in spontaneous reports of adverse reactions, including syncope, which are temporally correlated with a change in the formulation of liquid Leukine to include edetate disodium (EDTA). The upward trend in adverse reaction reporting rates has not been observed with the use of lyophilized Leukine. Healthcare professionals should immediately stop using liquid Leukine and return unused vials to the manufacturer.
• Thyrogen. Genzyme Corp. announced that the FDA has approved a supplemental indication for Thyrogen® (thyrotropin alfa for injection) to be used in combination with radioiodine to ablate the remaining thyroid tissue in patients who have had their cancerous thyroids removed. The FDA approved Thyrogen for remnant ablation based on results from a clinical study which suggest that treatment with Thyrogen is similar to withdrawal from thyroid hormone in achieving ablation, and that it could significantly reduce the side effects of thyroid hormone withdrawal by allowing patients to remain on hormone replacement therapy.

Big Stone, Lincoln, and Pine Counties in Minnesota have a rising trend of cancer death rates. How does your county fare? Click here.

For more data on cancer in Minnesota, visit the Minnesota Cancer Surveillance System.

For specific information about Minnesota's comprehensive cancer control plan, click here

As a member of the local and state-wide oncology community, the specifics of your state’s plan for dealing with comprehensive cancer control are of particular importance. Defined by the Centers for Disease Control (CDC) as “a collaborative process through which a community and its partners pool resources to reduce the burden of cancer,” the specifics of a state’s comprehensive cancer control program are spelled out in state plans. All 50 states have such plans that describe the strategic actions a state is taking to address the prevention and treatment of cancer.

For further information about state comprehensive cancer control measures, click here to read an Oncology Issues article by Leslie S. Given and Karin Hohman.

The Association of Community Cancer Centers (ACCC) will present its 34th Annual National Meeting at the Baltimore Marriott Waterfront Hotel in Baltimore, Md., on April 2-5, 2008. ACCC's Annual Meeting is the perfect opportunity for your entire cancer care team (physicians, nurses, administrators, and billers/coders) to strengthen their skills and network with their colleagues. Learn about Medicare rule changes, physician/hospital alignment, contract negotiation, compendia changes, quality improvement...and much more. ACCC's Annual National Meeting offers practice tracks with hands-on and timely information to help your practice and the entire multidisciplinary cancer team.

Read the agenda.

Read more and register.

The National Institutes of Health (NIH) asked the Institute of Medicine (IOM) to study the delivery of psychosocial services to cancer patients and their families and identify ways to improve it. The IOM defined psychosocial health services ias: "psychological and social services and interventions that enable patients, their families, and health care providers to optimize biomedical health care and to manage the psychological/behavioral and social aspects of illness and its consequences so as to promote better health."

In its October 2007 report, the IOM examines the inclusion of psychosocial services as appropriate cancer care. The report is entitled: Report Brief, October 2007, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.”