Oncology billing is important to submit claims and get reimbursed for cancer care services. Oncology is a complex medical field dealing with intricate diagnostic tests and treatment methods. A huge variety of oncology billing codes is used in this field. Diagnostic codes, laboratory codes, chemotherapy codes, radiation oncology billing codes, and medication codes are at the top of the list. A thorough understanding of oncology billing codes is important for accurate medical coding and billing processes.
In this article, we will learn about various types of oncology codes and their importance in medical billing. We will discuss the types of oncology services covered by billing codes. And here you can also read about billing for oncology practices.
Understanding Of Oncology Billing
Oncology is the medical study that deals with the diagnosis, treatment, and prevention of cancer. Cancer is a serious ailment, and if left untreated, the prognosis is very bad. Oncology codes are used to bill different types of healthcare given to cancer patients.
Oncology billing includes detailed documentation of rendered services provided from patient presentation in healthcare practice to the final management plan. Each phase should be documented to comply with federal and state healthcare regulations.
Healthcare professionals also need to stay updated with new rules and regulations to undergo an accurate billing process. An accurate billing process leads to a smooth and rapid reimbursement cycle, which is necessary for the financial growth of healthcare practice.
Common CPT Codes In Oncology
1. Evaluation and Management (E/M) Codes
E/M codes are used when a patient present with certain symptoms and is evaluated by a healthcare professional. During these consultation sessions, an evaluation of symptoms is done, a diagnosis is made, and a management plan is decided. E/M codes also bill follow-up and care planning sessions. There are many E/M codes that differ from each other depending on the complexity of the medical conditions and the type of healthcare provided. Below are some important evaluation and management codes:
- 99202-99205: These oncology billing are used to bill the new patient office visits. The specific code is selected depending on the time duration spent with the doctor and the complexity of medical decision-making. Initial evaluation and diagnosis are made in these sessions.
- 99211-99215: These codes apply to established patient visits. Patients come for routine follow-ups to monitor treatment progression. Providers also adjust management plans during these sessions.
- 99231-99233: These codes bill for hospital follow-up visits for postoperative patient care. Side effects of chemotherapy, recovery, and complications of treatment are discussed in these sessions.
2. Diagnostic and Laboratory Billing Codes
Diagnosis is the cornerstone of oncology patient care. Diagnosis confirmation and type of cancer is done through laboratory and pathology procedures. Laboratory tests also tell about the staging of the cancer, which is helpful in deciding the treatment option.
- 88104-88112: These oncology codes bill for the cytopathology services. Fine needle aspiration cytology (FNAC) and pap smears are used to take biopsies of suspicious tissues. Biopsies are examined to differentiate between benign and malignant conditions.
- 88300-88309: Services like examining tissue biopsy under the microscope to know the grade, type, and malignant nature of tissue are billed under these codes.
- 81210-81383: Cancer occurs due to mutation in genes and these mutations can be detected in the DNA by genetic testing as a preventive measure. 81210-81383 codes bill genetic testing services.
3. Imaging And Radiology Codes
Imaging and radiology techniques like X-rays, CT scans, and MRI are helpful in the diagnosis and monitoring of cancerous tissue in the body. Hire our billing services for Radiology Practice here. Below are the important codes described:
- 77067: This code refers to routine screening mammography to detect signs of breast cancer. Screening mammography is done in patients with genetic history or risk factors for breast cancer.
- 74177: Bill abdominal and pelvic CT scans which are used to assess the size and progression of tumours.
- 78815-78816: These codes bill for advanced imaging techniques known as PET (Positron Emission Tomography) scans. A PET scan is used to identify cancerous areas by visualizing increased metabolic activity.
4. Chemotherapy And Medication Codes
Chemotherapy is very useful in decreasing the size of cancerous mass and making the prognosis better. Other medications are also administered for treatment purposes. Below are oncology billing codes that cover above services:
- 96401 – 96450: These codes are used for billing for the administration of chemotherapy drugs. Providers need to choose suitable oncology codes depending on the route of administration, i.e., intravenous (IV), intramuscular (IM), and subcutaneous.
- 96365 – 996368: These codes are used to bill drugs other than chemotherapy agents. Administration of hydration therapy drugs, antibiotics, antiemetics, and steroids are generally billed under these codes.
- J9000 – J9999: Expensive treatments like the use of monoclonal antibodies and targeted therapies are billed under special codes like J9000 – J9999.
5. Radiation Oncology Billing Codes
Radiation therapy is considered the backbone of cancer treatment as it has positive results with a good prognosis. For radiation therapy, planning, delivery and patient care holds significance in oncology care. These services are covered by the following codes:
- 77261 – 77263: These codes bill for sessions in which radiation therapy planning is designed considering the patient’s health and cancer type.
- 77401 – 77418: These radiation codes refer to techniques like external beam radiation therapy and intensity-modulated radiation therapy (IMRT). Cancer tissues are targeted, sparing the healthy tissues.
- 77385 – 77387: Sometimes, providers render image-guided radiation therapy (IGRT) in which imaging technology is used to target the exact site. This IGRT technique comes under these codes.
Specialized Oncology Billing Codes
There are some special billing codes in addition to common codes. Specialized billing codes are used for billing for procedures like surgical and interventional techniques. Bone marrow transplantation codes also come under this category. Also read this blog to know more about CPT info for Oncology Consultation.
1. Surgical Oncology Codes
Surgical oncology refers to the processes in which diseased tissues are resected for diagnostic and therapeutic purposes. Cancer spread can be avoided by surgical removal of affected parts of the body.
- 19301: This code covers the lumpectomy in which only a diseased portion of the breast is removed. A few centimeters of surrounding healthy tissue are also removed to be on the safe side.
- 38571: Metastatic tumors spread from the primary organ to nearby lymph nodes. Therefore, lymph nodes are removed as a conservative procedure, which is billed under 386571.
- 49255: Bills for the removal of cancerous mass from the abdominal cavity in case of gastrointestinal or ovarian cancer.
2. Interventional Oncology Codes
In the modern era, open surgical procedures are becoming obsolete, and minimally invasive techniques have come to the market. These techniques give the same outcome as open surgery with fewer complications and health concerns.
- 47382: In the case of liver tumors, radiofrequency or microwave ablation techniques destroy the cancerous cells without damaging the surrounding tissue. These techniques are billed under 47382.
- 32555: This code refers to the thoracocentesis in which extra pleural fluid is drained to relieve symptoms. Thoracentesis is performed in case of pleural effusion.
3. Bone Marrow Transplantation Billing Codes
Bone marrow transplantation has emerged as a life-saving therapeutic procedure in hematologic cancers. There are various codes used to bill these services.
- 38240: This bone marrow transplantation code covers how bone marrow is harvested from the donor person.
- 38241: Covers transplantation of bone marrow into the recipient. This code is very expensive because of the complexity of the procedure.
Tips For Accurate Oncology Billing
Oncology billing is a complex and time-consuming process. Any mistake can lead to claim denial and potential revenue leaks. Therefore, it is recommended to take suitable measures to increase the efficiency of this procedure. Documentation is very necessary for internal and external audits. Insurance companies also ask for detailed documentation about the rendered medical services to cancer patients. Accurate documentation brings transparency to the billing process.
Technology has emerged as a blessing for decreasing administrative burdens and enhancing the efficiency of any process. Providers can use billing software and tools to automate and streamline the billing process. If you still face errors in medical billing despite taking all the necessary measures, you need to hire billing experts. Billing experts take over your oncology billing processes and bring good results. Hiring an expert team can be helpful in decreasing the claim denial rate, ultimately leading to financial growth.
Conclusion
Oncology billing codes cover cancer care services rendered to cancer patients. Oncology codes are complex, and providers should understand the correct use of oncology billing codes to maintain the reimbursement cycle. There are various oncology codes covering evaluation and management services, imaging services, chemotherapy, and radiotherapy. Some specialized codes are also introduced for surgical and interventional methods.
Surgical and interventional methods are used for diagnostic as well as therapeutic purposes. Bone marrow transplantation codes have also been added to the list in recent years. Correct use of billing codes helps healthcare providers decrease the claims denial rate and enhance revenue generation. Providers can also hire an expert billing team to take over billing processes for better management.
FAQ - People Also Asks
Oncology treatment is complex and billed by numerous CPT codes. For chemotherapy, 96401–96450 are used, while radiation therapy is billed under 77401–77418. There are also other CPT codes that bill surgical procedures and interventional procedures.
In oncology billing, medical bills are generated, and claims are submitted to the insurance companies to get reimbursement for the rendered healthcare services. Diagnostic tests, consultation sessions, management plans, and follow-ups are included in cancer care services.
99223 is an evaluation and management (E/M) code that bills initial inpatient hospital care. During these E/M sessions, detailed medical history, detailed medical examination, and decision-making of a complex nature are performed.
96401–96450 refers to chemotherapy billing codes. A suitable chemotherapy code is used in medical bills considering the route of administration like IV, IM, or subcutaneous. Special chemotherapy codes, including J9000–J9999, cover expensive agents like monoclonal antibodies and targeted therapies.