November 2018

How do you #AnswerTheQuestion?

By Malika Siker, MD
Radiation oncology represents a small specialty in medicine, accounting for less than 1 percent of the physician workforce and graduate medical education trainees.  Although the work we do is highly rewarding, the intimate and challenging nature of our work can be isolating in both our professional and personal spheres. Reaching out and sharing experiences with colleagues has been suggested as an effective way to avoid burnout and improve wellness. However, due to our small numbers and demanding schedules, it is difficult to find avenues to regularly receive support from peers.
Social media has emerged as a tool to form meaningful connections with colleagues in this modern environment. Participating in social media has many benefits, such as facilitating the dissemination of important research and discussions of current issues in radiation oncology. Additionally, the ability to connect with others to advocate for our patients and our specialty as a whole, to network professionally and to provide encouragement and support for colleagues lure many users to this space, particularly to Twitter. It is these simple interactions that can provide the most meaning in an otherwise very noisy and lonely place.
The radiation oncology community recently explored these issues on Twitter in response to an article written by pediatric oncologist Chris Adrian, MD, in the New England Journal of Medicine. In this article, Dr. Adrian described the difficulty and complexity of answering the simple, common “cocktail party” question, “What do you do? How can you do it?” After sharing this article with the #radonc community, I asked others to share how they answer this question. The sincere, thoughtful and uplifting responses from our diverse community provided followers with much inspiration. Below are some highlights of the #radonc #AnswerTheQuestion replies:
Randall Kimple, MD, PhD: The trust our patients place in us is an honor and a privilege. We come into their lives when they are vulnerable and scared. We support them, cure some, and are always driven to do better. It drives me to find better treatments in the lab so that we can help future patients.
Matthew Katz, MD, FASTRO: Vulnerability and strength come with facing a serious illness. Our role as teacher, healer means patients and clinicians both can bring our strengths and vulnerabilities together to build trust, even in the face of uncertainty.
Kaleigh Doke, MD: We are oncologists that have the privilege of helping #cure and care for patients with #cancer using the coolest, most advanced treatments in #radiation—a treatment that’s been in existence for a century!
Lauren Colbert, MD, MS: We do it because we are eternal optimists, and even for those without a positive outcome, it is such a sacred opportunity to provide relief in the midst of pain. Wouldn’t do anything else!
Anna Lee, MD, MPH: We offer relief for the disease burden of cancer patients and provide hope so that patients can be the best version of themselves!
Drew Moghanaki, MD, MPH: We are just people helping people who are suffering and need us. About as close to God’s work as one can get.
Raphael Yechieli, MD: We help people live better each day. By offering treatment FOR people, and not just doing things TO them.
Emma Holliday, MD: We meet patients where they are. Sometimes we give them a cure, sometimes we give them hope, sometimes we give them relief from suffering, sometimes we give them peace that they have done all they could. Always we give them respect, dignity and love.
Ashley Albert, MD: We are so privileged to be able to meet patients where they are ... in their vulnerable state, facing adversities and victories. We have a means to provide cure or comfort. The gratitude of our patients pushes us all forward and motivates us to press on.
Sabin Motwani, MD: It's always a privilege when someone but especially #cancer patients entrust you with their health. They are appreciative for the little things you can do for them and for each day of life they have. They are great teachers who continue to inspire us. As radiation oncologists and lifelong learners, that is why we love to work so hard for them.
Fumiko Ladd Chino, MD: I #AnswerTheQuestion by saying that there's too much pain, grief and suffering in cancer care. Our treatments are true #precisiononcology ... tailored to each person: their risks, symptoms and anatomy. Even when we can't cure, we can improve quality of days.
Benjamin King, MD: Providing answers for the scared, physical/emotional relief from those in pain, and connecting in a disorienting time are all blessings given to us as #cancer doctors and why I choose to do #radonc every day.
Jeff Michalski, MD, MDA, FASTRO: I emphasize the positive (which is 90 percent of my clinical #radonc work). I actually #CURE patients of what were previously incurable diseases. You can't say that about diabetes (endocrinologist), multiple sclerosis (neurologist), arthritis (rheumatologist), coronary artery disease (cardologist), etc.
We invite you to join the conversations of our #radonc community on Twitter. Simply follow the #radonc hashtag to discover the current research, controversies and news in radiation oncology. Additionally, we hope that by participating in this community, your life will be meaningfully enriched by the support and encouragement of your colleagues and that you will reach and help others with your own voice.
Let us know in the comments how you #AnswerTheQuestion.
Posted: November 20, 2018 | 0 comments

Radiation Oncology Reimbursement Reminders (RORR), Fall 2018

By Jessica Adams, ASTRO Health Policy Analyst
In addition to providing resources to assist practices in submitting accurate claims for reimbursement, ASTRO is actively working with payers on coverage and payment issues. Recently, we received questions regarding reimbursement for radium-223 dichloride (Xofigo) and CMS’ Targeted Probe and Educate program. The following Radiation Oncology Reimbursement Reminder is drawn from our many coding and reimbursement resources to help practices properly bill for this treatment.
What is the appropriate treatment planning code to use for the delivery of radium-223 dichloride (Xofigo)?
Complex radiation treatment planning (CPT code 77263) is used when the radiation oncologist performs the cognitive work associated with treatment planning and the service meets the definition of complex. The use of radium-223 dichloride meets the criteria for billing CPT code 77263.
What criteria do recovery audit contractors (RACs) use under CMS’ Targeted Probe and Educate (TPE) program?
CMS requested that RACs use National Coverage Determinations (NCDs) when performing an audit, as these determinations are more consistent than Local Coverage Determinations, which vary by Medicare Administrative Contractor.
ASTRO members and their practices should be familiar with the following NCDs:  
Members should also review ASTRO’s Coding Guidance regarding simulation and intensity-modulated radiation therapy (IMRT) planning. The  Office of the Inspector General (OIG) issued a report that found that Medicare overpaid U.S. hospitals an estimated $21.5 million between 2013 and 2015 for simulation (77280, 77290) when performed as part of IMRT planning (77301).
Finally, we have an example of a private payer relieving some administrative burden for radiation oncology practices. Anthem recently removed several Radiation Therapy procedures from their prior authorization list. As of early August, Stereotactic Radiosurgery (SRS), IMRT Planning, IMRT multi-lead collimator (MLC) device and IMRT Treatment Delivery codes no longer require prior authorization. These procedures are all included in ASTRO’s Model Policies, which outline correct coverage policies for radiation oncology services.
We hope that this guidance helps radiation oncology practices as they navigate billing issues. Do you have billing questions or any other common billing pitfalls? Let us know in the comments, or attend ASTRO’s third Coding and Coverage Seminar, taking place December 7-8. Registration is open and filling up fast!

To purchase ASTRO’s Coding Resource, which includes information on updated CPT codes, visit our website. Or, if you’ve already purchased the Resource, you may access it by logging in to your MyASTRO account and clicking on Virtual Meetings/Products under My Resources.
Posted: November 7, 2018 | 0 comments