Oncology is a clinically-focused specialty that is undergoing frequent technological and process updates. It requires a high degree of physician’s skill, experience and the urge to learn to stay tuned with the revisions related to documentation, coding, billing, and revenue cycle management (RCM).

Common Oncology-Specific Coding Errors :

Errors abound. Some of the many are:

• 1. Coders are not up-to-date with on-going changes in codes and related modifiers.
• 2. Failure to capture correct levels of CPT (Common Procedural Terminology) codes.
• 3. Under-coding and over-coding errors.
• 4. Misusing modifiers, using of wrong modifier and mixing up of modifiers.
• 5. Coders are not conversant with coding for specialist oncology services such as bone marrow procedures, transplantations, and blood transfusions.
• 6. Coders round off drug administration times instead of noting the exact time.

What the Experts Have to Say :

According to oncologists, correct coding is the main ingredient for successful practice. The complexity and regular updating of coding system contribute to unintended coding errors. According to the American Society of Clinical Oncology (ASCO), failure to complete the code capture at the time when oncology procedures are provided is common.

Continued usage of codes that have been eliminated by Medicare continues to be the bane of the US oncologists. A survey conducted by two nationally recognized experts in oncology practice management-Roberta Buell from OnPoint Oncology LLC and Patrica Falconer from Health Options, on behalf of the Association of Northern California Oncologists (ANCO), revealed that only 1 out of the 14 surveyed practices had updated their oncologists about the elimination of consultation codes by Medicare.

According to Cynthia Stewart, coding education coordinator president of AAPC, problems arise for coders when physicians fail to document the steps they went through to arrive at a diagnosis. Enos further clarifies that coders need to understand the depth or extent of medical decision making. Medical decision depends on complete documentation to make a “medical necessity linkage” between the procedure performed and the diagnosis code.

Tips to Ensure Correct Coding :

There are umpteen of them – to name a few :

• 1. Be aware of on-going changes in codes and modifiers.
• 2. Continually train oncologists and coders on coding mistakes and consequences, along with how to avoid the mistakes.
• 3. Do not neglect equipment or instrument used : Be conversant with recent codes related to the equipment or instrument (e.g. for radiation oncology) used to provide oncology services.
• 4. Beware of the tendency to code according to the complexity of the diagnosis, rather than the extent of decision making involved.
• 5. Be aware of new or established (existing) office visit codes and in-patient visit codes established by Centres for Medicare and Medicaid Services (CMS).
• 6. Make sure you understand the billing rules and regulations for Medicare and private payers. In fact, with the high cost of new cancer therapies, many oncology practices are now verifying insurance information before every treatment.
• 7. The American Medical Association’s (AMA) multi-specialty Relative-Value Update Committee (RUC) frequently reviews and updates oncology codes. Keep in sync with these changes.
• 8. Oncology clinics and hospitals will find the guidebook on billing and coding for oncology-related services offered by American Society of Clinical Oncology (ACCO) very useful.

Escapade from the Oncology Coding Malaise :

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Here’s our presentation on 8 Oncology Coding Tips !