Catch Radiation and Home Visit Changes Coming Soon to Medicare Manual

Medicare has announced two updates to the Medicare Claims Processing Manual (MCPM). The implementation date is set for Aug. 27, 2019, but they’re effective all the way back to Jan. 1, 2019. If your physician performs home visits or superficial radiation treatment, you’ll want to be sure your knowledge is up to date.

1. Eliminate Home Visit Documentation Requirement

If you’ve been keeping up with E/M documentation requirement changes, you know that Medicare removed the requirement for the medical record to include medical necessity for a home visit in place of an office or outpatient E/M in 2019. Now the MCPM is catching up by revising content about this rule.

As of Aug. 15, 2019, MCPM, chapter 12, section, which is applicable to home visit E/M codes 99341-99350, states, “For home services provided by a physician using these codes, the beneficiary does not need to be confined to the home. The medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit.”

That last sentence about documenting the medical necessity will soon be deleted, according to Transmittal 4339, CR 11273.

2. Watch for E/M Possibility on Superficial Radiation Tx Days

That same transmittal includes another change to the manual, which confirms that you may report an office/outpatient E/M code from 99211-99213 on the same date of service as superficial radiation treatment delivery. Here are the specifics:

  • The update is in MCPM, chapter 12, section 30.6.17, which is new
  • The title is Physician Management Associated with Superficial Radiation Treatment
  • The added content states, “Evaluation and management codes for levels I through III (99211, 99212, and 99213) may be billed with modifier 25 [Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service] when performed for the purpose of reporting physician work associated with radiation therapy planning, radiation treatment device construction, and radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.”

The MCPM addition also points you to MCPM, chapter 13, section 70.2, for guidance on services bundled into radiation treatment management codes. If you head to that chapter, you’ll see that the MCPM addresses the same topic for superficial radiation treatment delivery there, adding that radiation therapy planning may include, but is not limited to, clinical treatment planning, isodose planning, and physics consultation.

These MCPM sections don’t specify the code digits, but look at 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day). The current Correct Coding Initiative (CCI) edits (effective July 1, 2019) bundle 99211-99213 into 77401. All of the edits have a modifier indicator of 1, which means you may override the edit with an appropriate modifier. As the new manual content mentions, you should use modifier 25 on the E/M code.

What About You?

Do you code for a physician who performs home visits or superficial radiation treatment? Do you found these changes helpful?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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