Treatment Specialty Diseases

Oncology massage is a specific type of bodywork that is targeted toward boosting the healing process of those who are undergoing treatments for cancer. Cancer patients frequently experience side effects from chemotherapy and other treatments, such as surgery and radiation, that cause increased pain, fatigue, low blood count, nausea, insomnia and decreased immune system function.

Oncology massage therapy uses gentle massage as well as reflexology and acupressure to help fortify both the physical and emotional well-being of the patient. Reflexology applies light pressure to the reflex zones of the foot, which encourages the equilibrium of the related body system and organs. Acupressure targets distinct points on the body in order to foster physical and emotional balance. The massage is gentle and of limited duration, providing comfort and support to the healing process.

Until recently, massage was contradicted as a treatment for cancer patients because of the belief that massage could actually cause cancer cells to metastasize by causing cells to dislocate from the cancerous area and regroup in other parts of the body. However, noted cancer research centers have approved the use of massage therapy, as there is no data to support the opinion that massage can cause metastasis, and the positive benefits outweigh the theoretically possible risk.

It is important to note that those who have had lymph nodes removed and are at risk for developing lymphedema need to consult a qualified oncology massage therapist, as massage can cause lymphedema if applied incorrectly. Massage does in fact benefit those who suffer with lymphedema by providing manual lymph drainage, which reduces the swelling of tissue and helps to remove toxins and waste from the area.

The emotional and psychological benefits of therapeutic massage for those undergoing cancer treatments are an important component to the physical healing process. Cancer patients often describe their treatment as being invasive, painful, and extremely difficult to endure. An oncology massage therapist respects the unique needs of each patient, applying gentle strokes as not to cause further pain or injury.

Studies have shown a decrease in anxiety, pain, insomnia, depression and nausea among those receiving chemotherapy, radiation and surgery. Massage provides a nurturing touch and helps to empower patients to take a positive step in their healing process. Therapeutic massage provides a respite from invasive procedures and their side effects, helping to restore a sense of tranquility and positivity to those courageously fighting this disease.

Gastroenterology is a medical specialty that deals with the digestive system and its disorders. Gastroenterologists use a number of diagnostic procedures to accurately identify the patient’s medical condition and prescribe treatment. Coding for gastroenterology involves accurate coding of the various procedures and services offered by the physician. Reimbursement is offered for procedures provided in in-office, in-facility, hospital outpatient and ASC facility settings. Payment policies vary with individual payers and therefore these should be verified before providing treatment to identify limitations if any, on diagnosis, site of service or coding requirements.

Common Gastroenterology Procedures

• ERCP (endoscopic retrograde cholangiopancreatography) – this procedure combines the use of X-rays and endoscope. It is used to identify disorders such as gallstones, tumors, cysts, blockages and narrowing in the ducts.

• Sphincterotomy – to treat abnormalities diagnosed during an ERCP

• EUS (endoscopic ultrasound) – ultrasound of the pancreas, transduodenal or transgastric

• Sigmoidoscopy – enables the physician to view the lower end of the colon.

• Gastroscopy – this helps to examine the lining of the oesophagus, stomach and duodenum using an endoscope.

• Colonoscopy – is utilized by physicians to have a direct view of the whole of the large bowel or colon.

Upper Gastrointestinal Procedures and Codes

Upper gastrointestinal procedures include endoscopic and esophagoscopic procedures. These help the physician to view the interior of the upper GI tract including the esophagus, stomach and duodenum. When billing for Upper GI procedures, you have to verify payer conditions for covering the procedure. The services are usually covered when medical conditions such as esophageal disease, anemia, gastric ulcer, Celiac disease, persistent upper abdominal symptoms, and involuntary weight loss have been diagnosed.

• Diagnostic esophagoscopy

• Esophagoscopy with biopsy

• Esophagoscopy with foreign body removal

• Esophagoscopy with electrocautery removal of tumor or polyp

• Esophagoscopy with snare removal of tumor or polyp

• Esophagoscopy with dilation

• Esophagoscopy with control of bleeding

• Esophagoscopy, rigid or flexible; with transendoscopic ultrasoundguided intramural or transmural fine needle aspiration/biopsy(s)

• EGD – simple primary examination

• (dagger) EGD – diagnostic

• Upper gastrointestinal endoscopy with transendoscopic ultrasoundguided intramural or transmural fine needle aspiration/biopsy(s) esophagus (includes endoscopic ultrasound examination limited to the esophagus)

• (dagger) EGD with biopsy

• EGD with transendoscopic catheter or tube placement

• Upper gastrointestinal endoscopy with transendoscopic ultrasoundguided intramural or transmural fine needle aspiration/biopsy(s)(includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate)

• EGD with PEG tube placement

• EGD with foreign body removal

• EGD with electrocautery removal of tumor or polyp

• EGD with snare removal of tumor or polyp

• EGD with control of bleeding

Some Important Considerations

A comprehensive endoscopic evaluation of the upper GI tract has to be reported with the code 43235. This usually involves a detailed view of the esophagus, stomach and duodenum and a thorough examination of the duodenal bulb. Physicians should use code 43239 to report EGD (Esophagogastroduodenoscopy) with biopsy. An EGD that is provided just as a primary examination and does not include “comprehensive” components can be reported with the code 43234. Lesser services such as esophagoscopy and esophagoscopy with biopsy should be reported only using their specific codes, 43200 and 43202 respectively. Physicians should avoid the practice of adding modifier -52 to 43239 to signify these reduced services, because this usually results in pointless delays or even denials of payment. When reporting biopsies and procedures for removing foreign bodies, physicians should take care to choose the code that clearly specifies these.

In cases where more than one procedure is carried out during a single visit, physicians should ensure whether these come under the multiple endoscopy payment rules. Here, Medicare as well as most private payers will reimburse the full value of the highest-valued procedure, along with difference between the value of the remaining procedure and the base endoscopic procedure. Modifier -51 has to be used along with the lesser-valued procedure.