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Medical Billing & Coding Guidelines For Oncology 2023

Oncology is the branch of medicine that deals with the treatment and diagnosis of tumors. Oncologists play a vital role in helping patients recover from cancers. Although, oncology is quite a complex and attention-demanding medical field. However, oncology billing and coding is a way more complicated procedure impacting the revenue growth of healthcare to a great level.

Today, several healthcare labs are accustomed to adopting new technologies and updated electronic health records (EHR). however, one thing you don’t want to experience for your practice is claim denials/ rejections.

The most common reason for inefficient revenue growth & insufficient reimbursements for healthcare providers are claim denials and rejections. Which are caused by applying incorrect and outdated medical codes.

You may be accustomed to adopting new technologies and modern electronic health record (EHR) software solutions that allow you to automatically apply medical codes and prepare medical bills, but one thing that you should definitely not overlook i.e. whether the Current Procedural Terminology (CPT) codes is updated.

Often medical codes are pre-downloaded to your EHR, but if you’re not sure if the medical code is new then you might opt for a less accurate medical code. If the medical code is outdated and it isn’t recognized by your insurance company anymore then you will definitely won’t get paid for your hard-earned services.

The American Medical Association introduced a new set of CPT codes on Sep 9, featuring 393 changed medical codes. It also includes 225 brand-new codes, 75 deleted codes and 93 revised medical codes.

“It can be tempting to ignore new codes when they’re released and leave them to the back office staff, but oncologists really need to get a feel for new CPT codes as well,” said Julie Belle, CPC, a medical coder based in Garner, North Carolina.

“If you don’t know the differences between the codes, you may not document thoroughly enough for the coder to select the right procedure code, and this could cause you to submit incorrect codes. This may mean you don’t collect the right amount, or could even lead to fraud accusations,” she added.

In this article, you can learn some particular changes in oncology medical coding and billing services that became effective as of Jan 1, 2023.

Newly Added CPT Oncology Codes 2023

Lately, it’s been established that the new code for laparoscopic prostatectomy is addressed in combination with surgical codes to describe the prostate.

When a healthcare provider tends to use robotic assistance to remove the prostate then he/she uses 55867 (Laparoscopy, surgical prostatectomy, simple subtotal including control of, vasectomy, urethral calibration, postoperative bleeding and/or dilation, meatotomy, and internal urethrotomy), along with robotic assistance, when performed for the treatment).

Newly Added Lab Codes For Oncology 2023

An oncology billing and coding specialist should also check out for the new lab codes that reflect tests performed on patients with cancer or for those patients who are being diagnosed for cancerous conditions i.e.

Newly Added Lab Codes Description Example
81451 Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis
81441 Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2
81449 Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis
81456 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis

Don’t Forget New Cat III CPT Code

Another thing to notice in the updated oncology medical coding guidelines is the addition of new Category III code to CPT codes in 2023. The newly added Category III code for oncology is 0739T (Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation).

If you use magnetic filed induction to ablate malignant prostate tissue then you should use the 0739T code to address your services after Jan 1, 2023.

What Is The Purpose Of Category III CPT Codes?

Category III codes reflect innovative and modern technologies, emerging procedures and oncology services etc. The more likely you use this code, the more data of your services will be collected on its use.

Also remember, this code has no assigned Relative Value Unit (RVU) or established payment payments which means that the reimbursement is at the payer’s discretion. However, you should make sure to include the operative report, a copy of the U.S. Food and Drug Administration approval letter, and a letter of medical necessity to help support your medical claims.

Now you’ve learned the changes that you need to make in order to upgrade your oncology coding system according to the legal regulations and current industry standards.

However, in order to stay on top of your competitors, you need to leverage innovative oncology medical billing solutions to streamline your oncology healthcare revenue cycle management (RCM) and improve your finances.

What Are The Most Effective Oncology Medical Billing Solutions In 2023?

Here are the proven medical billing solutions for oncologist helping you to reduce errors and mistakes in your healthcare revenue cycle management and improving the ways that can help you get full compensation for your hard-earned services.

Upgrade Your EHR & Medical Billing Software To Comply With The Changes

It is accustomed that several healthcare practitioners tend to to use EHR and medical billing software that allows them to prepare medical bills automatically.

However, these software solutions come up with built-in medical codes that help healthcare providers and medical coders to instantly prepare medical bills without going through the labor-intensive procedure of verifying and validating the usability of medical codes.

Having said that, when the legislative institutes introduces new medical codes or apply changes to the existing codes then you have to tune your software in order to comply with the updates.

In case of non-compliant medical codes, the health insurance companies don’t recognize medical codes in your patient record and medical claims giving them a reason to deny paying your reimbursements.

In order to stay afloat of the billing challenges, you need professional assistance to keep your software and practice management solutions incompliance with the ever-evolving requirements of medical coding environment.

A professional oncology medical billing company can help you stay ahead of the billing challenges by guiding you at every step of healthcare revenue cycle management.

A medical billing agency works as a virtual extension of your office team and coordinate with your staff to improve your business functions. Since they’re always living in the pool of medical billing and coding world, therefore, their subject-matter experts can help integrate new medical coding and billing changes in your practice management.

It helps you consolidate your IT setup and streamline your business workflow.

Use Bundled Oncology Codes Wisely

Removing a tumor seems like a one-man show, however, it requires a collective effort of physicians, labs, and multiple doctors to ensure the patient's well-being during the treatment.

In the previous versions of CPT and ICD-10 codes, there were several medical codes used separately to address multiple diagnostic and medical procedures for the patient recovery.

However, the latest versions of oncology codes have enabled healthcare providers to use bundled codes to address multiple procedures done on the patient. FYI, a bundled code is a single CPT code that is used to describe two separate procedures that were performed at the same time. Usually, code bundling requires a healthcare provider to use the code for the more significant procedure when a minor procedure is performed at the same time.

For example, Medicare Anesthesia Rules don’t allow separate payment for anesthesia for a medical or surgical procedure when the physician is performing any medical procedure with limited exceptions.

Therefore, the provider shall not report CPT codes 00100-01999, 62320-62327, or 64400-64530 for anesthesia for the medical procedure. Also, the healthcare provider can’t unbundle the anesthesia procedure and report component codes separately. E.g. a healthcare provider shall not address introduction of a needle or intracatheter into a vein (which is addressed by CPT code 36000), venipuncture (CPT code 36410), drug administration (CPT codes 96360-96379), or cardiac assessment (e.g., CPT codes 93000-93010, 93040-93042) when these procedures are related to the delivery of an anesthetic agent.

Get Full Compensation With The Complete Documentation

As a healthcare provider you know that Detailed Medication Notes, Administration, and Hydration Information require an extensive amount of time for execution. Usually, several doctors proceed with these time-intensive tasks to avoid unfavorable results (i.e. claim denials & revenue loss) when submitting medical claims for their services.

The tests and examinations for multiple components to identify errors and mistakes that are associated with the medical treatment provided to the patient should also be included in the services that are meant to be paid by the insurance company.

Therefore, if a doctor omits the fine details about the extra services and E&M then there are high chances that won’t receive full compensation for their services.

This can be further explained by the following example; let’s say a patient has begun cancer but the oncologist needs to make sure if it has spread to other different areas of the body or if it could develop into malignant cancer to ensure the patient’s safety and accurate treatment.

However, after the diagnosis, the healthcare provider comes across the results that the cancer is under control so he gives the patient medication instead of just writing benign cancer detected. Which makes the doctor get paid considerably less.

As a result, evaluating a patient involves much more than simply recording the main complaint i.e. it also includes negative and favorable findings that require a wholesome diagnostic procedure. Therefore, healthcare providers should also mention these details to indicate the appropriate level of doctor’s examination.

Outsource Oncology Medical Billing Services

If you’re struggling through maintaining and tracking all the details about the services delivered to the patient (from early diagnosis, cancer screening, and care planning and coordination) and also completing your documents for the continuous follow-ups of the patients even after the treatment then outsourcing oncology billing services can be go-to solution for you and your practice.

A professional oncology medical billing company such as CureCloudMD can help you get fairly paid for your services by assisting you in the long journey of delivering satisfactory patient care services.

From the experience of successful oncology practices, it is concluded that thorough paperwork of the entire treatment and diagnosis process enables healthcare providers to get their reimbursements that are justifiable for the hardwork they put into the treatment of their patients.

CureCloudMD can help you in streamlining all your business functions and cover you with a complete range of medical billing and coding outsourcing services. Along with the billing solutions, we also provide medical credentialing, account receivable (AR) recovery, claim denial management, and medical billing audit services. Schedule a free billing consultation session with our team and get a free custom quote.