Coding and Billing for Oncology: An Essential Guide February 14, 2022
Coding is the backbone of medical practices. Oncology facilities are no different, as well. If you need help on coding and billing for your oncology practice, check out this essential guide.
An Overview of Oncology
The field of oncology focuses on diagnosing, treating, and researching cancer. Oncologists are doctors who work in this field. However, some oncologists specialize in only a few types of cancer or treatments. Oncology therapy has three main components: medical, surgical, and radiation. Depending on the type, stage, and location of cancer, a patient may receive treatment from multiple oncology specialists.
Medical oncologists also develop treatment plans for cancer patients. The oncologist may recommend surgery, chemotherapy, targeted therapy, or hormone therapy while coordinating with other oncologists who play a role in the patient’s treatment.
Meanwhile, a surgical oncologist uses biopsies and other cancer-related procedures to remove tumors and the surrounding tissues.
Radiation oncologists also specialize in treating cancer with radiation therapy. Doctors can perform a procedure that shrinks or destroys cancer cells if a patient has cancer. They can also alleviate cancer-related symptoms.
Oncology subspecialists treat many types of cancer. For example, oncologists trained in gynecology treat cancers of the female reproductive system. Neuro-oncologists treat cancer of the brain, spine, and peripheral nerves.
What Makes Coding and Billing for Oncology Practices So Critical?
Correct coding practices are crucial to oncology coding and revenue payments. If there are coding errors, you are sure to lose revenue. Avoid it at all costs.
Moreover, billing and coding errors are a risk for healthcare professionals because oncology drugs are expensive. A lack of accurate and proper oncology coding will significantly impact revenue cycle management.
Every treatment course should be billed from the start and again as needed.
Current Procedural Terminology (CPT) Codes Used in Coding Oncology:
- CPT code 77332:
CPT code 77332 corresponds to simple treatment devices, designs, and construction that include simple port blocks with one or two premade blocks that can be hand-positioned; simple prefabricated bolus that can be shaped for an individual patient; or independent jaw motion or asymmetrical collimation.
- CPT code 77333:
Use CPT code 77333 if you need an intermediate treatment device that includes multiple port blocks, like corner pelvis blocks, beam splitter blocks, midline spinal cord blocks, stents, bite blocks, or a special multi-use bolus.
- CPT code 77334:
The above CPT code is used for complex treatments, designs, and constructions. It includes customized, one-use bolus, for example, wax molds conforming to particular body parts, along with customized blocks of low alloy, customized compensators, wedges, molds, and casts, including customized immobilization devices and eye shields.
- CPT code 77336:
The above code is used for continuous medical radiation physics consultation. These include the assessment of treatment parameters, assurance of quality in delivering perfect dosage, and review of patient documentation. A radiation oncologist reports for a week of treatment, including once every five treatments.
- CPT code 77370:
During radiation therapy, use CPT code 77370 when a problem or a special situation arises. For this code, the requesting physician must provide a detailed description of the problem.
- CPT code 77387:
Guidance for localization of target volume for radiation treatments, including intrafraction tracking, should use CPT code 77387. Only OPPS uses this code.
Important Note: These codes identify only the technical component of radiation treatment sessions and not any physician involvement.
Only treatment management codes are included in the professional component. In addition, insurance companies agree to pay for these terms and conditions for delivering radiation treatment under CPT codes 77401-77416.
- CPT code 77401:
The above code is used for superficial/orthovoltage treatment delivery for a day. You cannot submit codes for clinical treatment planning – 77261, 77262, and 77263, for treatment devices with codes – 77332, 77333, and 77334, for isodose – 77306 and 77307, for physics consultation – 77336, and treatment management – 77427, 77431, and 77470 with 77401.
- CPT code 77407
In the above code, any of the following criteria are met, but not all complex criteria. The criteria include two treatment areas, three or more ports, and three or more single blocks. Please note that OPPS is the only program that uses this code.
- CPT code 77412:
When there is a need for complex treatment delivery, use the CPT code 77412. There are three or more separate treatment areas, custom blocking, tangential blocks, sedges, rotating beams, or tissue compensation that do not meet guidelines. OPPS uses this code exclusively.
- CPT code 77295:
A three-dimensional radiotherapy plan that includes a dose value histogram is reported with this code, including procedures performed in coplanar therapy beams. Due to this, the below codes can’t be billed separately on the same date. The codes are 77280, 77285, and 77290.
- CPT code 77300:
Based on the course of treatment, code 77300 is for radiation dosimetry, calculation, central axis depth, TDF, NSD, gap calculation, off-axis factor, tissue homogeneity factors, according to the order of treatment when prescribed by a health care provider.
Dosimetry recalculation may result from any changes in weight or birth at the time of radiation treatment. Moreover, daily performing this procedure every time a patient receives treatment is unnecessary.
Guidelines for Providing Proper Documentation:
- Never attach any patient or treatment details to the original claim.
- Ensure all services are billed with detailed information, itemization, and supporting documentation.
- Provide clean treatment histories.
- Document a medical professional’s involvement.
Overall, the CPT codes here are from the Centers for Medicare & Medicaid Services (CMS). We hope you found this Oncology billing and coding information helpful.
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