California   Oncology  Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc .

J u n e 19 2 0 1 8
This Weekly's Hot Topics  
  • California state appeals court issues stay, End of Life Option back in effect.(California News)
  • The Trump Administration is seeking stakeholder feedback.(National News)
  • Submit ideas by June 29 for CMS' Promoting Interoperability (CMS News)
California News 
- The state appeals court has issued a stay, at least for now, putting California's End of Life Option back into effect. California's law, allowing terminally ill people to end their lives, was declared unconstitutional last month by a judge because it was voted on during a special session. The Fourth District Court of Appeals in Riverside issued an immediate stay last Friday putting the End of Life Option back into effect. The court also gave opponents of its decision until July 2 to file objections. The Associated Press: State Appeals Court Reinstates California's Right-To-Die Law. 
- California seeks to clear coffee of cancer risk warnings. If approved, the proposed regulation could be a win for the coffee industry, which lost a year-long battle in the Los Angeles Superior Court over a law that could require warnings be placed on all packaged coffee sold in the state.
OEHHA has initiated a proposed rulemaking clarifying that exposures to Proposition 65 listed chemicals in coffee created by and inherent in the roasting of coffee beans and brewing of coffee do not pose a significant cancer risk.   A public hearing on the proposed rulemaking is scheduled for August 16, 2018 at 10 am (PDT) in the CalEPA Headquarters Building, 1001 I Street, Sacramento. A public-comment period on the proposed rulemaking will close on August 30, 2018.    
- The California Medical Association's (CMA) Practice Resources (June 2018) is now available online at and features articles entitled CMA urges Health Net to rescind recently announced payment policies; Thank you physician members-we defeated AB3087; AB72 independent dispute resolution process: how CMA can help; Have you received your Prop 56 supplemental Medi-Cal payments yet?; United Healthcare implements Smart Edits into the EDI class process; The Coding Corner: Reporting E/M services with tie as the controlling factor.
- Join MOASC & ANCO PAC lobbyist, Nicette Short, and California Assemblyman Freddie Rodriguez for a CPAT webinar Monday, June 25, 2018, 12pm - 1pm (PDT), to address California's diverse public health challenges. RSVP:
To view the invitation click HERE.  
Noridian News  
Noridian/JEMAC has the following updates on their website
* MLN Connects Provider eNews
Announcements: CMS Opioids Roadmap; Billing for Stem Cell Transplants-Reminder
Claims, Prices & Codes: FY2019 ICD-10-CM Diagnosis Codes
Publications: Improvements of Hospice Billing and Claims Processing MLN Matters Article-New; Update on Hospital OPPS: July 2018 MLN Matters Article-New; Transition to New Medicare Numbers and Cards Fact Sheet-Revised; Avoiding Medicare Fraud  & Abuse: A Roadmap for Physicians Web-Based Training-Reminder; Remittance Advice Resources and FAQs Booklet-Reminder
* Chest X-Ray Policy LCD-Effective June 22, 2018
Upcoming Noridian/JEMAC webinars include: 
* Medical Review Findings of Care Plan Overview (CPO) Webinar (June 19)
* Modifier 59, NCCI and MUE Webinar (June 21)
* Noridian Medicare Portal Registration and Functionality Webinar (June 21)
* Mammography, Pap Test and Pelvic Exam Webinar (June 26)
* Beneficiary Forms: When and Why Providers Issue Them Webinar (June 26)  5 p.m. Pacific  Read the complete update
* Part B, Home Health & Hospice Collaborative Webinar (June 27)
Visit for more information and to register.
MOASC News  

- The link below is the final 3rd party group letter, signed by MOASC and 57 other groups, sent to Sec. Azar and to Hill offices regarding 340B reform. Rep. Doris Matsui (D-CA) introduced a provider-friendly bill to reform the 340B drug discount program, including explicitly laying out a purpose for the 340B program that says hospitals do not necessarily have to forward drug discounts to patients and reversing the CMS cut to hospitals' Medicare reimbursement for 340B drugs. The legislation is a counterpoint to much of the 340B reform legislation introduced, to date, as well as the president's drug pricing blueprint, and suggests that discussion over how to change the program could continue for some time. Read more: Inside Health Policy, Matsui's Provider-Friendly 340B Bill Would Reverse CMS' Cuts, Clarify Program's Intent.  340B Letter to Administration  


MOASC and ANCO are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all MOASC members in mid-May and is available online at A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.


- MOASC has communicated with Noridian regarding 96402 denials. The most recent response from Noridian is, "...Claims are being adjusted.  Noridian does not have the timeframe on this.  Noridian would suggest calling the call center in case they have more information. It takes a while to get these processes done.  Noridian expects that any claims submitting going forth should process correctly, but physicians and providers may want to test a few before submitting a batch..." MOASC still waits for a Production Alert to be posted, but it has not been at this time.

Not satisfied with Noridian's response, MOASC has now communicated with Neal E. Logue, Health Insurance Specialist, Division of Financial Management and Fee for Service Operations, Centers for Medicare & Medicaid Services (CMS), CMS San Francisco Regional Office, who requests that MOASC & ANCO members please send, by FAX (443) 380-6310 to his attention, two or three specific claim examples including the name of the beneficiary, the beneficiary's Medicare number, date of service, name of provider, and the provider's national provider identifier (NPI).  Upon receipt of the requested information, CMS will review the reason for the denials.  Please do not send the requested information by email, but you may submit the information by FAX which is secure.  Thank you.


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ANCO News  
ANCO and MOASC are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all ANCO members in mid-May and is available online at A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.
ANCO is organizing a series of Hematologic Malignancies Updates in 2018. The first Update took place on June 16 at the Sacramento Hyatt Regency with Gabriel Mannis, M.D., University of California, San Francisco, Joseph Tuscano, M.D., University of California, Davis, Jeffrey Wolf, M.D., University of California, San Francisco, and Naseem Esteghamat, M.D., University of California, Davis. The latest research on novel treatment modalities for hematologic malignancies--leukemias, lymphomas and myeloma--along with case studies for these diagnoses were presented. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the presentations The next Update  takes place on September 15 in Palo Alto; watch for an announcement and registration form in August.
- ANCO members may register at a discounted rate for the 19th Annual International Lung Cancer Congress (Hyatt Regency Huntington Beach, July 26-29) at
- SAVE THE DATE: ANCO'S ASCO Highlights 2018 will take place on August 25 at The Claremont Resort in Oakland. Watch for an announcement and registration form in late June.
National News

- Continuing with Men's Health Month, here are some Fast Facts from the CDC:
  • The most common kinds of cancer among men in the U.S. are skin cancer, prostate cancer, lung cancer, and colorectal cancer.
  • Most prostate cancers grow slowly, and don't cause any health problems in men who have them. Treatment can cause serious side effects. Talk to your doctor before you decide to get tested or treated for prostate cancer.
  • A human papillomavirus (HPV) vaccine is recommended routinely for boys at 11 or 12 years of age to prevent anal cancer and genital warts. The vaccine also is recommended for all teenage boys and men through age 21, any man who has sex with men through age 26, and men with compromised immune systems (including HIV) through age 26, if they did not receive all doses of the vaccine when they were younger.
- The Trump Administration is seeking stakeholder feedback on the American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. The document identifies challenges in the American prescription drug market, such as high list prices for drugs, and high and rising out-of-pocket costs for consumers. The Administration also provides a blueprint for addressing these challenges and identifies four key strategies for reform: improved competition, better negotiation, incentive for lower list prices, and lowering out-of-pocket costs. ASH plans to submit comments, which are due on July 16 and welcomes your feedback. If interested, please reach out to Leslie Brady
The International Myeloma Foundation presents Living Well with Myeloma Teleconference Series, The Importance of Bone Health and Treatment Updates: What Patients & Caregivers Need to Know, Wednesday, June 20, 2018. Faculty:
Noopur S. Raje, MD,Massachusetts General Hospital Cancer Center, ad
Beth Faiman, PhD, RN, MSN, APRN-BC, AOCN, Cleveland Clinic Taussig Cancer Institute Wednesday, June 20, 2018   4pm Pacific/5pm Mountain/6pm Central/7pm Eastern Duration: 60 Minutes (includes Q&A). Click here to Save the date and Register!
- The Office for Civil Rights (OCR) has issued a new guidance regarding Individual Authorization of Uses and Disclosures of PHI for Research. The guidance explains particular requirements for future research as it pertains to authorization to use or disclose Protected Health Information and clarifies aspects of the individual's right to revoke an authorization for research uses and disclosures. The guidance includes a detailed discussion of each of the three topics identified in the Cures Act. The Cures Act requires the Secretary of the Department of Health and Human Services (HHS) to issue "Guidance Related to Streamlining Authorization" under HIPAA for uses and disclosures of protected health information (PHI) for research.
Click Here to download the PDF Guidance.
- A draft of the Fiscal Year 2019 funding bill for the HHS that was released Thursday by the House Appropriations Committee includes $38.3 billion for the NIH, including funding for the All of Us, Cancer Moonshot and research initiatives. "These funds will greatly benefit numerous medical research programs, combat opioid abuse and support the search for cures for many cancers and diseases," said Rep. Tom Cole, R-Okla.
- The American Hospital Association said data to support ICD-10 coding for patients' social determinants of health can include non-physician documentation from social workers, nurses, case managers and others. The AHA said codes Z55 through Z65 are not new but are not commonly used. Health IT Analytics
- Clarification for billing anemia, according to the 2018 ICD-10-CM Official Guidelines for Coding and Reporting.
* When the reason for the encounter is to manage anemia associated with a malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced first, followed by the appropriate code for anemia.
Example: A 47-year-old female patient with a diagnosis of lung cancer presents to her oncologist, reporting excessive fatigue and decreased tolerance to exercise. A lab test performed by the oncologist determines the patient has anemia due to the lung cancer.
ICD-10-CM coding:
C34.90    Malignant neoplasm of unspecified part of unspecified bronchus or lung
D63.0   Anemia in neoplastic disease
Remember: When the reason for the encounter is to manage anemia caused by a malignancy, sequence the malignancy code first, followed by the anemia code.
*When the reason for the encounter is for management of anemia associated with the adverse effect of chemotherapy, immunotherapy, or radiation therapy, the anemia code is sequenced first, followed by the appropriate code for the neoplasm and the adverse effect code (T45.1X5 Adverse effect of antineoplastic and immune suppressive drugs)
The same guideline applies to management of radiotherapy (Y84.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure)
Example: A 68-year-old male with prostate cancer receiving chemotherapy visits his oncologist to receive a Procrit® injection for anemia caused by the chemotherapy.
ICD-10-CM coding:
D64.81   Anemia due to antineoplastic chemotherapy
C61    Malignant neoplasm of prostate
T45.1X5A   Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
Remember: When the reason for the encounter is to manage anemia for an adverse effect, sequence the anemia code first, the malignancy code second, and adverse effect code third.
To learn about complete blood count testing for red blood cells, read the article "Examine Testing for Complete Blood Counts without Platelets" in AAPC's Knowledge Center
CMS News 
By FRIDAY, June 29, submit your ideas to CMS! CMS is accepting proposed measures for inclusion in the Medicare Promoting Interoperability program, formerly known as meaningful use. Stakeholders may that focus on the improvement of health data exchange and interoperability, advanced use of 2015 edition certified EHR technology, patient safety, outcomes measurement, and streamlined program effectiveness, efficiency and flexibility. EHR Intelligence.
- Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Meetings
08/22/2018 - Chimeric Antigen Receptor (CAR) T-Cell Therapy and Patient Reported Outcomes
- Last week, CMS released updates to the Merit-based Incentive Payment System (MIPS) eligible clinicians by updating the MIPS Participation Lookup Tool and renaming it the Quality Payment Program (QPP) Participation Lookup Tool and adding predictive Qualifying APM Participant (QP) status. Eligible clinicians in Advanced Alternative Payment Models (APMs) who meet certain criteria are considered QPs and are excluded from MIPS. A priority for the QPP has been to provide eligible clinicians their QP status as soon as possible to minimize clinician confusion and provide clarity on what they need to do to meet reporting requirements. Clinicians will now be able to check their participation status in the QPP through one tool. For more information:
- Clarification of last week's California Oncology Weekly article about CMS' modification of Medicare Claims Processing Manual policy update on documentation for evaluation and management (E/M) services, allowing the teaching physician to verify the medical record in which the student documents. The student can document any and all elements of the E/M service and the teaching physician just has to verify the documentation rather than re-document their activities. The teaching physician must personally perform (or re-perform)the physical exam and medical decision making activities of the E/M service being coded and billed BUT they have to verify any student documentation in the medical record. They can add or modify to the student documentation in the medical record. The MLN article makes it clear the teaching physician does not have to re-document what is already documented by the medical student.
Verify in E/M is key. The word VERIFY stands out in the MLN article. It is the job of the teaching physician to verify the medical student's documentation in addition to personally performing the physical exam and medical decision making. As a result, a sample "attestation" for medical student documentation, would be something like:
"...I verified the medical student's documentation in the medical record. I personally performed a physical exam and medical decision making. I made appropriate changes to the documentation and the assessment and plan based on my verification, exam and medical decision making" Signed Teaching Physician..."
The official instruction, CR10412, issued to your MAC regarding this change is available at
- CMS' star rating system has been wrong for two years, per analysis by Chicago's Rush University Medical Center. The CMS' last four star ratings releases relied heavily on a single measure to determine how well hospitals performed in the safety group, which dramatically affected overall ratings. Read More
Affiliate Association News 
- ASCO has issued an endorsement of the Society for Integrative Oncology Clinical Practice Guideline on Integrative Therapies During and After Breast Cancer Treatment . Read the guideline at
- On July 10, ASH, along with the Lymphoma Research Foundation and the National Comprehensive Cancer Network, is co-hosting a briefing on Capitol Hill to educate Members of Congress and staff on chimeric antigen receptor (CAR) T-cell therapy. This innovative treatment, currently approved for certain patients with leukemia and lymphoma, is used to treat the sickest of the sick, typically individuals who have exhausted all other treatment options, including chemotherapy, radiation, or stem cell transplant.  The briefing will provide an opportunity for attendees to learn about the development of CAR T-cell therapy, the way in which CAR T-cell therapy treats blood cancer, and to hear directly from a patient about her own treatment experience. Confirmed speakers include MOASC member, Dr. Joseph Alvarnas, City of Hope, Duarte, CA, Chair, ASH Committee on Practice. Please reach out to Leslie Brady for more information.
- Help steer the meeting discussion by providing input today, for the   ASH Summit on Emerging Immunotherapies for Hematologic DiseasesJuly 12 & 13, 2018. The Summit will feature interactive breakout sessions aimed at addressing important topics relevant to the design and application of immunotherapies. These small-group sessions will create a unique opportunity for attendees to steer the conversation and help chart the course for the field. Please complete a short pre-meeting survey to help facilitate scientific discourse during the breakout sessions.
- The Medicare PROPOSED Regulations for 2018 will be out around the 1st of July . onPoint Oncology and Bobbi Buell are scheduling the following Lunch and Learn Webinars:
Proposed 2018 Medicare Regulations: Offices and Hospital Outpatient  on 7/20/2018 and 7/27/2018 at 9 AM PDT (12 noon EDT, 11 AM CDT, 10 AM MDT)
These are free webinars as thanks to our cancer community .  If you cannot attend, please feel free to pass on your invitation to someone in your organization.
- The best new scientific research in all areas of hematology will be presented at the 60th ASH Annual Meeting and Exposition in San Diego, California. We encourage all hematology researchers to submit an abstract by August 1 at 11:59 p.m. Pacific time. More than 1,000 abstracts will be presented orally, with thousands more accepted for poster presentations. All accepted abstracts will be published in Blood. Don't miss this great chance to showcase your research in front of the brightest minds and influencers in the field of hematology!
Visit the ASH website for a full list of abstract review categories, policies, and eligibility requirements.
- ASCO is requesting you to submit an abstract for the Palliative and Supportive Care in Oncology Symposium, November 16-17, 2018 in San Diego, California. Innovative and cutting-edge research is growing across the field of palliative and supportive care, underpinned by continuing advances in symptom science. This symposium is the ideal venue to present your research to colleagues interested in the integration of palliative and supportive care across various cancer care settings. Abstract Submission Deadline: July 24 at 8:59 PM (PDT).
- ASH members can now sign up to report data for the Merit-based Incentive Payment System (MIPS) through Healthmonix's MIPSPRO, a 2018 Qualified MIPS Registry.   Healthmonix will submit data directly to the Centers for Medicare and Medicaid Services (CMS). MIPSPRO will walk members through the measure selection process, ensuring the appropriate requirements are met. Clinicians can register and report individually, or a representative from a practice can report for multiple providers within that practice.   To get started simply follow this link, register, and choose a package. Watch the MIPSPRO demo to learn more about how everything works.    
- COA and their Pharmacist group, COPA, are needing your help to send to them ANY & ALL PBM delay stories, as well as any other stories where patient care is compromised.  
Several fronts, including legislative (federal and state levels) and legal are being tapped into!  The message MUST go out far and wide. Below are some quick links to a couple of projects that COPA board members have been working on. There are links to two articles and one podcast below that are very well done regarding the challenges that we all face surrounding PBMs and them restricting our ability to care for our patients. 
Please send your stories to Ricky Newton at COA. Thank you.
- ASCO invites all practices to participate in the 2018 ASCO Practice Census, an annual survey of the entire U.S. oncology practice community that aims to capture keep information on what is happening in oncology practice today and that is chronicled as part of ASCO's State of Cancer Care in America initiative. Complete the Census at
New ASCO Guidelines have been published
NCCN has published the following updates at :
Breast Cancer (V1.2018), Lung Cancer Screening (V1.2019), Smoking Cessation (V1.2018), Merkel Cell Carcinoma. These NCCN Guidelines® are currently available as Version 2.2018 Noninvasive Breast Cancer (V1.2018), Older Adult Oncology (V1.2018), Thyroid Carcinoma v1.2018.
Industry News 
- Pharmacyclics LLC informs MOASC & ANCO of an important update regarding IMBRUVICA® (Ibrutinib). In addition to the one pill, once daily formulation, Pharmacyclics LLC has decided to continue to offer IMBRUVICA® in the 140mg capsule formulation at the current price. The decision to continue to offer IMBRUVICA® in a capsule formulation maintains flexibility for health care providers and patients. Pharmacyclics is committed to providing IMBRUVICA® in a form that works best for health care providers and patients.
Please click here for a link to a company statement that contains more information regarding this decision.
- The FDA granted approval to Avastin in combination with chemotherapy, followed by Avastin alone, for the treatment of women with advanced (stage III or IV) ovarian cancer after initial surgery. The Genentech press release including Important Safety Information is linked here. With this approval, Avastin is now approved in the U.S. for ten distinct uses across six different types of cancer - including four gynecologic oncology indications in four years.
Merck informs ANCO and MOASC that the USFDA has approved Keytruda for the treatment of adult and pediatric patients with refractory primary mediastinal large B-cell lymphoma (PMBCL), or who have relapsed after two or more prior lines of therapy. In addition, the USFDA has approved Keytruda for patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy whose tumors express PD-L1 (CPS greater than or equal to 1) as determined by an FDA-approved test.
Pfizer US Oncology  informs ANCO and MOASC that CMS has assigned Q5101 to Retacrit (for ESRD on dialysis, 100 units) and Q5106 to Retacrit (for non-ESRD use, 1000 units).

In This Issue

LunchTime Series

ANCO's ASCO Highlights
(Oakland, August 25) 
ANCO Hematologic Malignancies Updates (Palo Alto,
September 15)
The  Medical Oncology Association of Southern California (MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The  Association of Northern California Oncologists (ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge. The material contained in the California Oncology Weekly is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the California Oncology Weekly may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in California Oncology Weekly should not be used as a substitute for such advice. This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association.  All Rights Reserved.



MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006|

ANCO: P.O. Box 151109, San Rafael, CA 94915 |  P (415) 472-3960 | F (415) 472-3961 |