Oncology Medical Billing: An Explicit overview of Billing and Coding Guidelines

Oncology is a complex and lengthy procedure that demands comprehensive treatment plans to fight and eradicate cancer. Therefore, cancer treatment is a long and complex process. The Oncology Medical Billing process requires careful medical documentation of treatments and prompt communication with insurers for reimbursement. Accurate Medical Billing and Coding at the end of each phase of therapy will ensure that your clinic is paid in a timely manner.

Oncology Medical Billing and Coding are widely viewed as the pioneer of Oncology specialty practices. If the Coding is incorrect, you will certainly lose a substantial amount of money from your practice. Oncology Coding depends on precise codes, but at the same time, proper coding processes determine the amount of revenue. In a nutshell, this indicates your progress toward achievement.

What is Oncology Medical Coding?

The interpretation of a cancer patient’s files into universal codes that insurance carriers require from Oncology practices or institutes is known as Oncology medical coding. Oncology coders get their information from documents such as laboratory tests, transcriptions of oncologists’ notes, and radiologic reports.

Coders transform patient files into numeric or alphanumeric codes after arranging and reviewing them for errors. Oncology billers use these codes to establish claims that they will submit to insurance companies. To avoid claim denials and optimize payment collection from payers, Oncology coders ensure that they apply medical codes accurately.

What are the Oncology Medical Billing Codes?

The codes incorporated in medical billing and Coding divide into three categories: International Classification of Diseases, Tenth Revision and Clinical Modification (ICD-10-CM), as well as the current procedural terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS).

These codes are part of Oncology guidelines for billing enforced by the American Medical Association (AMA).

Oncology Medical Billing
Oncology Medical Billing

Healthcare providers, such as Oncology specialists, must adhere to HIPAA’s rules and regulations. If they don’t, it could result in significant fines per violation per year. Criminal penalties that carry the potential of a jail sentence are likely.

Commonly employed Oncology CPT Codes.

Here are some of the standard CPT codes Utilized widely in Oncology Medical Billing.

The CPT code 77332 has used for simple treatment devices, designs, and construction, including simple port blocks. Furthermore, its structure also takes in one or more hand positioned pre-maid blocks, simple pre-fabricated bolus that can shape for an individual patient or individual jaw motion or asymmetrical collimation.

The above CPT code is utilized for intermediate treatment devices, designs, and construction, including multiple port blocks. Moreover, it also takes in three or more blocks or pre-made blocks such as corner pelvis blocks, beam splitter blocks, midline spinal cord blocks, stents, bite blocks, and special multi-use bolus.

The CPT code 77334 is used for complex treatment devices, designs, and construction, including customized, single-use boluses like wax molds. Subsequently, it has customized blocks with low alloy, customized compensators, wedges, molds, and casts, as well as customized immobilization devices and eye shields.

The following code has been used for a continuous medical radiation physics consultation. It includes assessing treatment parameters, ensuring quality in delivering perfect dosage, and reviewing patient documentation. Alternatively, it supports a radiation oncologist reported for a week of therapy that includes once in every five treatments provided.

The above code provides separate and specific radiation physics consultations. Delivered when a particular issue has treated, or a particular event occurs during radiation treatment. This code implies a comprehensive description of the condition, as well as approving the physician’s request.

The codes mentioned above find uses in intrafraction tracking and guidance for target volume localization for administering radiation therapy.

Important Note: Radiation therapy procedures and delivery codes are often recorded once each treatment session. These codes can only recognize the technical component, not physician activity.

Professional component codes consist only of treatment management codes with professional components. Insurance companies agree to pay for specific terms and conditions for incorporating radiation therapy based on CPT codes 77401-77416 except 77407 and 77412.

This code is utilized for a day of superficial/orthovoltage radiation therapy. Never report clinical treatment planning – 77261, 77262, and 77263; treatment devices with codes – 77332, 77333, and 77334; Isodose – 77306 and 77307; physics consultation – 77336; and treatment management – 77427,77431 and 77470 with 77401.

The CPT Codes G6003-G6014 uses for intermediate treatment delivery when one or more of the following requirements are satisfied, but none of the complicated conditions are. The requirements are two treatment regions, three or more ports, and three or more single blocks. Remember that only OPPS uses this code.

The above CPT Code finds its uses for complicated therapy delivery if any of these requirements are met. OPPS only uses this code for three or more independent treatment zones, custom blocking, tangential blocks, sedges, rotational beam, or tissue compensation that do not match any criteria.

This code has been employed to report a three-dimensional radiation plan that contains a dose value histogram and operations done in coplanar treatment beams. As a result, the following codes are utilized, and they are not allowed to charge separately on the same day. These are the codes: 77280, 77285, and 77290.

This code is used for basic radiation dosimetry, computation, central axis depth, TDF, NSD, gap calculation, off-axis factor, and tissue homogeneity factors when only prescribed by a particular healthcare expert.

Any changes in the patient’s weight or birth date at the time of radiation therapy may need recalculation of the dosimetry. This technique does not have to repeat every time the patient receives treatment.

Oncology Medical Billing and Revenue Cycle Management

Patients who visit an oncologist are frequently experiencing health and financial difficulties. As a result of this combination, physicians must devote more time to each patient while simultaneously risking payment concerns due to under-or over-coding.

Outsourcing Oncology Medical Billing and revenue cycle management processes like compliance audit to a billing partner who knows the difference between a consultation and a new patient visit. Alongside, it ensures proper use of prolonged service codes, insurance for clinical trials, and codes for specific procedures like transplants. It can help maximize reimbursements and reduce claim denials.

Why choose NEO MD for Oncology Medical Billing Services?

When you outsource NEO MD to handle your Oncology Medical Billing, you have access to various resources. Providing HIPAA-compliant Oncology Billing services and utilizing front-line tools and technologies are just a few of several reasons to choose us as your medical billing and coding partner.

Our professionals are accessible 24/7 to answer your queries and provide prompt Oncology Billing. We offer both inexpensive and personalized billing and coding services. 

What Makes Us the Best Medical Billing Company?

NEOMD stood best among competitors due to the following cores 

Let’s schedule an appointment and discuss it in-depth with Oncology Billing specialists. Contact us now at (info@neomdinc.com) or (929) 502-3636).

Oncology Medical Billing
Oncology Medical Billing

FAQ’s

What is Oncology Coding?

The interpretation of a cancer patient’s files into universal codes that insurance carriers require from Oncology practices or institutes is known as Oncology medical coding. Oncology coders get their information from documents such as laboratory tests, transcriptions of oncologists’ notes, and radiologic reports.
Coders transform patient files into numeric or alphanumeric codes after arranging and reviewing them for errors.

Why Outsourcing Oncology Medical Billing is important?

Outsourcing Oncology medical billing to a third party considerably reduces medical billing discrepancies, which speeds up reimbursement and payment processing. This improves efficiency and increases revenue generation. Additionally, a flawless processing system attracts more clients used to the pace of today’s digitalized atmosphere.

What is Oncology Medical Billing?

Oncology is a complex and time-consuming procedure that comprises comprehensive treatment plans to combat and remove cancer. Oncology is one of the most rapidly growing fields of medicine.  According to reports, cancer survival rates in the US will increase by 31.4%. The survival rate of cancer patients will rise by 15.1 million as medical technology progresses.

What is Medical Claim?

A medical claim is a statement your healthcare provider submits to your health insurance provider for reimbursement. This outlines the services provided. It ensures that the physician is reimbursed, that your insurance will cover any benefits, and that you will be responsible for the rest. As soon as a patient arrives for an appointment, a claim gets started.

Which coding resources are used for Oncology Medical Billing?

All radiation oncology practices must use The Coding Resource as a coding reference. The ASTRO 2022 Coding Resource may be bought right now.  It provides revised CPT and HCPCS codes for 2022, as well as complete information on the RO Model.

What does an Oncology Medical Billing coder do?

A coder for oncology billing makes sure that all diagnostic procedures—such as chemotherapy, radiation transfusions, infusions, and injections—performed by a doctor or nurse are correctly coded. They look at the paperwork and the diagnosis findings to ascertain and evaluate patient information. ICD-10-CM, CPT, and HCPCS-compliant conditions and procedures must be entered correctly by the oncology coder.
A specialist in Oncology coding must be able to accurately determine and verify details for each encounter with a patient.

What are the Top 4 Trends in Radiation Oncology Medical Billing?

The medical landscape is constantly evolving. Here is a list of the most recent developments in radiation Oncology that might impact the way you bill.
Maintain Consistent Patient Records
Conduct regular Oncology Medical Billing Audit
Make sure accurate claim filings
Determine the Reason for Your Medical Claim Denials

How much do the medical billers charge per claim?

Healthcare providers often pay five to seven percent of their monthly revenue to medical billing service providers. This fee for medical billing services is determined on a percentage scale.
Charges per claim are another method that some healthcare professionals choose since it is more practical. The convenience for the cardiologists is one of the primary motivations for outsourcing cardiology medical billing.

Reference:

Oncology Care Model
Billing and Coding: Biomarkers for Oncology




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