C a l i f o r n i a O n c o l o g y W e e k l y
"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.
October 24, 2017
This W eekly's Hot Topics
  • Read the op-ed by ANCO President, Dr. Daniel Mirda on prior auth. & formulary. (California News)
  • TOMORROW is the last day to sign onto the Roberts/Carper MIPS letter (National News)
  • Read COPA white paper, "Improving Patient Outcomes and Coordination of Care:..." (Affiliate Association News)
California News 
MOASC & ANCO are continuing to work with state providers and organizations to advocate for reforms , and increase public awareness, to prior authorization and formulary exclusion policies. Please go to http://bit.ly/2zC90Td to read the op-ed by ANCO President, Dr. Daniel Mirda, published in the Napa Valley Register.
CMS has published a MLN Matters article entitled  Medicare Fee-for-Service (FFS) Response to the 2017 California Wildfires  at  www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17035.pdf.
Noridian News  
- Noridian/JEMAC has posted more updates to its website: 
* MLN Connects
Announcements--MIPS Virtual Group Election Period Ends December 1; Quality Payment Program: New Resources; SNF Quality Reporting Program Confidential Feedback Reports for Claims-Based Measures
Claims, Pricers & Codes --October 2017 OPPS Pricer File
Events --
Publications-- Medicare FFS Response to 2017 California Wildfires MLN Matters Article-New
* MolDX: OncoCEE; myPap; Mitochondrial Nuclear Gene Tests--Billing and Coding Guidelines
* Laboratory NCD Edit Software Changes for January 2018 CR10309
* MolDX: Know error Billing and Coding Guidelines Update
* MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease LCD-R5
* Medicare FFS Response to the 2017 California Wildfires SE17035
* Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified or Unlisted Service or Procedure Code Data Collection CR10232
Forthcoming Noridian/JEMAC webinars
* Basic E and M Avoiding Common Errors (October 24) 
* Noridian Medicare Portal Registration and Functionality (October 26)
Go to  https://med.noridianmedicare.com/web/jeb/education/training-events  for more information and to register.
  MOASC News
- THIS EVENING , Tuesday, October 24th, MOASC members, who are in the area, are encouraged to attend a reception in honor of Assembly Member Mike Gipson in Compton. CAPP is hosting the event and will be held at the Medical Offices of Dr. Toni Johnson Chavis (403 S. Long Beach Blvd., Compton, CA) from 5 p.m. - 7 p.m.  There is no cost to attend and there will be no soliciting contributions at the event.  RSVPs can be given to Tina De Vere White at 916.448.7992 x 3 or  tdeverewhite@micra.org .
- MOASC has signed a letter to key members of Congress urging their leadership to modernize the 340B program. A follow up letter thanking them for holding an informational hearing on the matter and encouraging continued support and prioritization of this important issue, was also sent with MOASC's signature.  The first group letter was very impactful and we want to keep the momentum going.   Key members of Congress who received the letter include California members who sit on the House Energy & Commerce Oversight & Investigations Subcommittee: Rep. Raul Ruiz, Rep. Mimi Walters, Rep. Scott Peters and Rep. Tony Cardenas. 
A second follow up letter is below. MOASC encourages, and invites your practice, to become a signer.  Please let Jennifer Zins, V-P, Perry Communications, Sacramento Jennifer@perrycom.com, know by COB this Friday, October 27th if you would like to sign on.  
Attached is a copy of the first group letter that includes organization names/logos. Thank you in advance for your consideration. CA340BGrpLtr2       340BCAGrpLtr-Bera 
DO NOT MISS the 2017 Administrator & Oncology Billing Programs, November 8th & 9th, from 8:30am to 12:30pm, at the DoubleTree Suites by Hilton Anaheim Resort - Convention Center. The program will highlight MACRA quality reporting scores and how not to miss your bonus through MIPS in 2019.
On Wednesday, November 8th , The Administrator's will hear Bobbi Buell discuss Benchmarking and Revenue Cycles, t he Impact of Rising Healthcare Costs with Dawn Holcombe and Systems Thinking Approach® to Strategic Management with Loren Tarantino, Global Partner, Haines Centre for Strategic Management, LLC, President, Loren Tarantino Consulting, Inc.
On Thursday, November 9th , the Biller's
will be presented A/R Billing Updates by Elaine Towle and Medi-Cal Updates. For more information, contact the MOASC office at moasc@moasc.org or 909-985-9061 x1. 
MOASC Member, City of Hope will present The Fourth Annual Gayle Brinkenhoff Breast Cancer Symposium on Tuesday, November 14, 8 am to 4pm. Objectives are to: Describe recent developments in the diagnosis, classification and molecular biology of breast cancer; articulate the impact & role of targeted and personalized therapy in the treatment of breast cancer, and manage challenging diagnoses with the implementation of new technology and testing modalities. For more information:  cme@coh.org  or (626)218-5622.
MOASC sent a letter of support to Susan R. Hansen, M.D., of the Physicians Advocacy Council's amicus curiae filed against Gov. Brown, in the American Association of Physicians & Surgeons, Inc. v. Jerry Brown Civil Action No. 2:16-cv-02441-MCE-EFB ). MOASC holds important perspectives on the doctor-patient relationship and concur with facts and arguments presented, and highlights the adverse impacts that California Assembly Bill 72 will have on this special bond and on these parties, individually.
- Fires, hurricane, tornado, earthquakes, broken pipe. These natural disasters and structural damage will never cease to impact your practice and patient's ability to get care. MOASC's OPEN Program is a link in the continuity of care continuum for patients and practices affected by such disasters. Whether local, regional, state, country or world-wide, assuring access to continuous care for the oncology patient is the goal of MOASC and their membership. Contact the MOASC Office at moasc@moasc.org for more information on participating and enrolling your patients in this program.
- MOASC continues to provide practice assistance and coding questions based upon member queries.
Recommendation #1: The History of' code guideline is: "When a primary malignancy has been previously excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy." Theoretically, if the cancer has recurred, there is evidence that the cancer is active.  You should query your clinicians and see if they agree. If they agree the cancer is then active at some level, the history of code is no longer applicable at that point. That is my interpretation the guideline, but there has been controversy about this issue.  See this article: Coding: Your Top Coding Concerns Solved | Physicians Practice --it's a bit outdated, but you get the point.  How you sequence it depends upon what is being treated:
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ANCO News  

- Four seats on the ANCO Board of Directors are up for election in 2017. ANCO seeks nominations for candidates for these seats. This year's election will be conducted via mail ballot in December. Candidates with the top four vote totals will serve for three years (i.e., 2018-2020, inclusive). Nominate an ANCO member (including yourself) to stand for election to the Board via e-mail/FAX to the ANCO office at  execdir@anco-online.org /(415) 472-3961.
Stanford Cancer Center's MDS Center is co-sponsoring the MDS Foundation's Educational Patient-Caregiver Forum on Saturday, October 28. The Forum takes place at 875 Blake Wilbur Drive, Room 2103, Stanford CA 94305 from 9:30AM through 2PM.
ANCO will host the 4Q2017 Hematologic Malignancies Update on November 4 at the San Francisco Hyatt Regency with Mehrdad Abedi, M.D., University of California, Davis, Sandy W. Wong, M.D., University of California, San Francisco, and Leena T. Rahman, M.D., University of California, San Francisco. The latest research on novel treatment modalities for hematologic malignancies, myeloma, and amyloidosis along with case studies for these diagnoses will be presented. This update is supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at  www.anco-online.org/4Q2017HemeMaligUpdate.pdf.
- ASCO member, David Gandara, MD, UC Davis, is chairing the one-day CME conference Best of WCLC 2017-San Francisco on November 11 following the 18th WCLC held in Yokohama Japan, October 15-18. The Eventbrite registration URL is  https://www.eventbrite.com/e/best-of-the-18th-wclc-san-francisco-tickets-37865231928 . ANCO members will receive complimentary registration when they register for an "Early Bird ANCO Member " ticket by October 20. For more information, please visit the Eventbrite website above.
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to  www.multicancers.org  for more information, to register, and arrange for housing.
National  News

- ASCO urges all ANCO and MOASC members to contact their Congressional Representatives to ask them to sign onto the Roberts/Carper MIPS letter to the Department of Health and Human Services urging exclusion of separately payable Part B drugs from the application of the MIPS adjustment. The last day to sign onto the letter is October 25. Visit the ACT Network at  http://cqrcengage.com/asco/app/onestep-write-a-letter?0&engagementId=409673&j=39709948&sfmc_sub=933038345&l=18416124_HTML&u=688256528&mid=10831477&jb=1&et_cid=39709948&et_rid=933038345&linkid=ACT+Network
 to contact your Representative.   
Anthem Blue Cross has announced that it is launching IngenioRx, a new pharmacy benefits manager, staring in 2020. In addition, they have also announced that they are partnering with CVS Health after their current PBM contract expires at the end of 2019. Read the  press release  for more information.
- In victories for Johnson & Johnson, courts reversed two judgments that awarded nearly $500 million to women who said they developed ovarian cancer from using the company's Baby Powder. The New York Times

Affiliate Association News 
- COPA has completed the white paper, "Improving Patient Outcomes and Coordination of Care: Importance of Oncology Dispensing in the State of New York." The link to the paper is noted below. Hopefully this can help others the same way it will help those in New York.
The American Board of Medical Specialties and its 24 member organizations are collaborating to re-evaluate how physicians are certified for continued practice. The initiative, called Continuing Board Certification: Vision for the Future, will bring together multiple stakeholders to create "a system of continuing Board certification that is meaningful, relevant, and of value." In the meantime, download ASCO's MOC App ( http://university.asco.org/mocapp? ).
ASCO recently joined nearly two dozen advocacy groups in sending a letter to House Energy and Commerce Committee leadership strongly opposing "right-to-try" (RTT) legislation currently under consideration. The letter urges the Committee to instead work on policies that would safely increase access to promising investigational therapies for patients. Read the letter at  www.asco.org/sites/new-www.asco.org/files/content-files/Patient-Orgs-Oppose-RTT.pdf  
ASCO and Friends of Cancer Research are calling for the use of more inclusive eligibility criteria for cancer clinical trials. Their joint research statement was published in the Journal of Clinical Oncology (JCO) at  http://www.ascopubs.org/doi/abs/10.1200/JCO.2017.73.7916 ).
ASCO's 2018 Quality Training Program, a comprehensive program designed to train oncology health care providers to investigate and implement data-driven quality improvement and manage clinical and non-clinical processes and outcomes, will take place in two locations--Miami and Alexandria. To learn more about and apply to participate in the Program, visit  www.asco.org/training-education/professional-development/quality-training-program .
Registration is open for the ASCO QOPI Fall Round that ends on November 7. For more information, visit  http://www.asco.org/advocacy-policy/asco-in-action/2017-qopi-fall-round-closes-november-07 .
- ASH invites you to attend their presentation of, Improving MDS Outcomes from Diagnosis to Treatment: A Multidisciplinary Approach, November 8, 2017 at the Westin Bonaventure Hotel & Suites, Los Angeles. This comprehensive, MDS-focused summit is a unique learning experience that encourages attendee interaction. Spread the word about this chance to improve MDS outcomes in your community through active learning for the entire care team!  Learn More
ASH will host a webinar on MIPS and Reporting for MIPS on November 13 at 10AM. The webinar will provide a specialized MIPS reporting plan for hematologists. If you are interested in attending this webinar, then please e-mail Leslie Brady at  lbrady@hematology.org  
Visit the 2017 ASH Meeting on Hematologic Malignancies Webcast for more than 11 hours of exclusive content at  http://ashondemand.org/Meeting/117851630.  
Year in Review , moderated by Neil Love, M.D., is a multi-tumor regional symposia series focused on the application of emerging research information to the care of patients with common cancers, is scheduled for Saturday, November 18, 2017 at the Fairmont Miramar Hotel in Santa Monica, CA. To register go to  www.ResearchToPractice.com/Meetings/YIR2017/CA.  
- Save the Date for #COA2018. The 2018 Community Oncology Conference is April 12-13 at the Gaylord National Hotel & Convention Center, just outside of Washington DC. To learn more about the Community Oncology Conference, visit:   http://www.coaconference.org/ .
The 2018 ASCO Annual Meeting, is scheduled for June 1-5, in Chicago, Illinois. This year's Presidential theme developed by Dr. Bruce Johnson is Delivering Discoveries: Expanding the Reach of Precision Medicine. Precision medicine is transforming cancer care in profound ways by driving the most exciting and powerful advances to improve how providers care for their patients. Bookmark  am.asco.org  and check back often for updates.
NCCN has published updates to the below. For the complete updated versions, please visit  NCCN.org . Recent updates include: adolescent and young adult cancers (V2.2018), central nervous system cancers (V1.2017), esophageal and esophagogastric cancer (V4.2017), gastric cancer (V5.2017), genetic/familial high-risk assessment: breast and ovarian (V1.2018), kidney cancer (V1.2018), melanoma (V1.2018), myeloid growth factors (V2.2017), myeloma (V2.2018), non-small cell skin cancer (V2.2018).
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (V2.2018). 
The NCCN Categories of Preference has been applied to the suggested treatment regimens. (CSLL-D) : https://www.nccn.org/professionals/physician_gls/pdf/cll.pdf.
- NCCN has announced the release of the newly-completed NCCN Radiation Therapy Compendium that includes information designed to support clinical decision-making around the use of radiation therapy in patients with cancer. Learn more at  www.nccn.org/professionals/radiation/default.aspx .
- NCCN has published NCCN Chemotherapy Order Templates (NCCN Templates®) for Acute Lymphoblastic Leukemia to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia, Version 4.2017.
- The following NEW NCCN Templates® have been published.
  • ALL36a - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) (Cycle A) alternating with High-Dose Methotrexate/Cytarabine (Cycle B) - HyperCVAD (Cycle A) Course
  • ALL36b - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) (Cycle A) alternating with High-Dose Methotrexate/Cytarabine (Cycle B) - High-Dose Methotrexate/Cytarabine (Cycle B) Course
  • ALL37a - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + RiTUXimab (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + RiTUXimab (Cycle B) - HyperCVAD + RiTUXimab (Cycle A) Course
  • ALL37b - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + RiTUXimab (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + RiTUXimab (Cycle B) - High-Dose Methotrexate/Cytarabine + RiTUXimab (Cycle B) Course
  • ALL2a - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + Dasatinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + Dasatinib (Cycle B) - HyperCVAD + Dasatinib (Cycle A) Course
  • ALL2b - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + Dasatinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + Dasatinib (Cycle B) - High-Dose Methotrexate/Cytarabine + Dasatinib (Cycle B) Course 
  • ALL3a - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + Imatinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + Imatinib (Cycle B) - HyperCVAD + Imatinib (Cycle A) Course
  • ALL3b - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + Imatinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + Imatinib (Cycle B) - High-Dose Methotrexate/Cytarabine + Imatinib (Cycle B) Course
  • ALL39a - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + PONATinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + PONATinib (Cycle B) - HyperCVAD + PONATinib (Cycle A) Course
  • ALL39b - HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) + PONATinib (Cycle A) alternating with High-Dose Methotrexate/Cytarabine + PONATinib (Cycle B) - High-Dose Methotrexate/Cytarabine + PONATinib (Cycle B) Course
  • ALL10 - Intrathecal Cytarabine
  • ALL32 - Intrathecal Methotrexate
  • ALL34 - Intrathecal Cytarabine/Methotrexate/Hydrocortisone
- NCCN has published updates to the NCCN Templates Appendices. 

The following NCCN Templates Appendix has been updated:

Appendix B: Carboplatin Dosing  

  • This appendix has been updated with a new FDA reference link, as well as the removal of Isotope Dilution Mass Spectrometry (IDMS) information.
- NCCN has published updated versions of the following NCCN Guidelines® with NCCN Evidence Blocks™: 
  • Non-Small Cell Lung Cancer, Version 9, 2017
  • Uterine Neoplasms [Endometrial Carcinoma], Version 1.2018
- Compendium (NCCN Compendium®) for Chronic Myeloid Leukemia. These NCCN Guidelines are currently available as Version 2.2018. 
  • The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)
  • The NCCN Compendium® has been updated to reflect the changes in the algorithm. (CML-3)



Industry News 
CORRECTION TO ANCO FAX NEWS (October 20, 2017) AstraZeneca informs ANCO and MOASC that Tagrisso is indicated for the treatment of patients with epidermal growth factor receptor (EGFR) T790M mutation-positive non-small cell lung cancer (NSCLC), as detected by an FDA-approved test, whose disease has progressed after EGFR tyrosine kinase inhibitor therapy.
Janssen Oncology invites ANCO and MOASC members to MACRA and the Quality Payment Program-What Does This Mean for Oncology? with Thomas Marsland, M.D., St. Joseph Health System, on November 7 at 12:30PM. For more information, please visit  www.anco-online.org/MACRAWebcast.pdf ; to register, visit  www.medforcereg.net/SOMP119713 .
Kite Pharmaceuticals informs ANCO and MOASC that the United States Food and Drug Administration has approved Yescarta, the first chimeric antigen receptor T cell (CAR T) therapy for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise classified, primary  mediastinal large B-cell lymphoma (PMBCL), high-grade lymphoma, and DLBCL arising from follicular lymphoma (transferred follicular lymphoma, or TFL).
In This Issue
Professional Educational Series 
 November 8-9

(San Francisco, Nov. 4)

(San Francisco, February 8-10) 

(San Francisco, January 25-27) 

(San Francisco, February 8-10) 

(Napa, March 16-18) 
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| www.moasc.org

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