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Oncology & Hematology Coding Alert

ICD-10-CM Coding:
Solve the Active vs. Personal History Dx Coding Conundrum
Hint: Treatment documentation is key. One of the most common areas of confusion when it c... Read more
Remote Physiological Monitoring:
Know the Dos and Don’ts of RPM Coding
Hint: Time is money. As healthcare technology advances, more digital medicine services ... Read more
Practice Management:
Improve Provider, Coder, Biller Relations, Improve Outcomes and Revenue
Three different roles, the same shared goals. In her 2024 Regional HEALTHCON presentatio... Read more
Reader Questions:
Compare and Contrast Modifiers 52, 53 in This Surgery Scenario
Question: What guidelines should I adhere to for a surgery cancelled midway because o... Read more
Reader Questions:
Debulking Services Means Removing Tumors
Question: A patient with recurrent ovarian cancer with previous TAH/ BSO undergoes ne... Read more
Reader Questions:
Bill Hydration With This Infusion? Not So Fast
Question: We are billing Medicare for a chemotherapy infusion. The patient received a... Read more
You Be the Coder:
Do This to Ensure Mole Removal Pay
Question: Our provider removed a mole from a patient's cheek and sent it off to path... Read more
News You Can Use:
Here’s the Big News in the 2025 Proposed Rule
No big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Ser... Read more
Modifier:
View These 3 Infusion Scenarios, Determine Separate E/M
Hint: Think above and beyond. Modifier 25 (Significant, separately identifiable evaluatio... Read more
HIPAA:
Examine These 3 Cases, Stay Safe from HIPAA Violations
Avoid the fate of these healthcare entities with solid training and compliance strategies.... Read more
Reader Questions:
Look Beyond Reimbursement When Reporting Z Codes
Question: Do the ICD-10-CM Z codes affect reimbursement, or are they strictly for sta... Read more
Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and ... Read more
Reader Questions:
Know This 2025 BIA-ALCL ICD-10-CM Guideline Update
Question: In addition to the new codes, are there any 2025 ICD-10-CM guideline update... Read more
You Be the Coder:
Beware Assigning High Level MDM for Cancer Dx
Question: If a patient has a cancer diagnosis, should be that be counted as an “acu... Read more
News You Can Use:
Know These 2025 ICD-10-CM Oncology Changes
And know why the changes are going to matter for Medicare billing. On Oct. 1, 2024, the ... Read more
E/M Coding:
Ask These 5 Questions, Accurately Calculate MDM Complexity Element
Hints: “Acute” may not be new, and “chronic” may not be specified by time. Assign... Read more
Revenue Cycle:
Hear From Those Affected by the Change Healthcare Outage
Reinforce your skills with paper-based claims. More than four months have passed since m... Read more
Reader Questions:
Pinpoint the Best Codes for This Breast Exam
Question: A 63-year-old patient presented for a diagnostic mammography exam with comp... Read more
Reader Questions:
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Reader Questions:
Understand CMS MUE Process for Same DOS
Question: Can we charge 77295 for two different body parts if the plan is signed on t... Read more
You Be the Coder:
Don’t Assume Linkage in This Anemia/Cancer Encounter
Question: If the patient has lung cancer and anemia, can we assume the anemia is due ... Read more
Genetic Testing:
Get the Answers to Your Frequently Asked Genetic Testing Questions
Here's how to make your way through the CPT® molecular pathology code set. “The geneti... Read more
Coding Quiz:
Correctly Code These Scenarios, Ace This Cancer Fatigue Quiz
Understand etiology and synonyms for accurate dx documentation. Cancer and fatigue go han... Read more
Reimbursement:
Find Your Way Through the Prior Authorization Maze
Hint: Don't forget to keep track of denials so you can troubleshoot your processes. Healt... Read more
Coding Quiz Answers:
Check Your Answers to Our Cancer Fatigue Coding Quiz
Don't forget to read inclusion terms carefully. Once you've answered the quiz questions o... Read more
Reader Questions:
Assign Codes and Responsibility for Code Choices
Question: Who is responsible for the final diagnosis used for an office/ outpatient e... Read more
Reader Questions:
Read Guidelines Closely for Breast Exam Documentation
Question: I have a radiology report stating the provider captured “ultrasound image... Read more
Reader Questions:
Let Purpose Determine Drug Administration Code Choice
Question: When a patient is receiving Lupron injections as part of their treatment fo... Read more
You Be the Coder:
Use This Tree for Correct Screening Mammography Coding
Question: If a patient is having a mammogram for a screening, you use the Z12.31. If ... Read more
Drug Coding:
Understand These 4 Problems Before Submitting Drug Claims
And stay alert to these expert billing tips and examples. There are a lot of moving parts... Read more
Modifiers:
Master Modifier 26, TC Coding With These 5 Tips
Hint: These modifiers can't separate every service. When your oncologist performs certai... Read more
Mythbuster:
Bust These Myths for Definitive SDoH Coding
Know the who, why, and what behind this critical new coding development. By now, most of ... Read more
Reader Questions:
Seek Out the Answer to This Separate Subspecialty Question
Question: I work for a fairly large oncology practice. We currently have medical onco... Read more
Reader Questions:
Code This Complication Dx Correctly
Question: If a patient suffers from an intra- or postoperative complication involving... Read more
Reader Questions:
Resolve the Right Way to Report This Tumor Resection
Question: What are the correct surgical and diagnosis codes to report for the follow... Read more
You Be the Coder:
Mend This Multiple Modifier Mess
Question: I have a denied claim for a patient who had 11 same-day lipoma removals. Th... Read more
Infusion Coding:
Get the Answers to Your IAC Coding Questions
Good news: They're a whole lot easier to manage than their IV counterparts. It's easy to... Read more
E/M Coding:
Know These 4 Things to Bill 99211 Correctly
And learn these three reasons for not reporting it. When one of your clinical staff membe... Read more
Care Management:
Remember These 5 Rules for Successful TCM Documentation
Don't let intimidating, extensive guidelines get in the way of clear coding. When a patie... Read more
Reader Questions:
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Reader Questions:
Beware Billing Multiple Radiation Therapy Units in This Scenario
Question: We billed one unit of 77290, 77318, and 77370, then billed again a week lat... Read more
Reader Questions:
Clarify HIPAA Terminology
Question: What is the difference between “consent” and “authorization” in the... Read more
You Be the Coder:
Take 2 Steps to Code Testicular DLBCL
Question: What is the correct coding for testicular lymphoma? I have always been told... Read more
Radiation Oncology:
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm... Read more
Coding Quiz:
See If You Can Ace This Aftercare/Follow-Up Quiz
Hint: You can't interchange these terms. You may think that follow-up care and aftercare ... Read more
Reimbursement:
Prevent Denials Before They Occur With These 4 Tips
Here's how to get all your documentation ducks in a row. If you've been experiencing an u... Read more
Coding Quiz Answers:
Check Your Answers to Our Aftercare/Follow-Up Quiz
Don't forget the difference between antineoplastic therapy and surgery aftercare. Once ... Read more
Reader Questions:
Phone-In This E/M Encounter
Question: We had a patient present to the office for a follow-up appointment. When th... Read more
Reader Questions:
Differentiate Between These Codes to Report NETs
Question: One of our oncologists documented “left kidney, NET [neuroendocrine tumor... Read more
Reader Questions:
Follow This Advice for First-Listed Dx
Question: When a new patient comes in to establish care with one of our oncology prov... Read more
You Be the Coder:
Modify Your Understanding of These Delivery and Treatment Codes
Question: We were denied for billing G6002 and 77412 with place of service (POS) code... Read more
Care Management:
Know How To Navigate the New PIN Codes
And see how they compare with principal care management. When the Centers for Medicare &a... Read more
ICD-10-CM Coding:
Get the Answers to Your Frequently Asked Neoplasm Table Questions
Check out these best practices to help you locate the right code every time. Oncology c... Read more
Cybersecurity:
Take These Top 10 Tips to Protect Your Practice from Cyber Threats
Here's how to avoid going on a phishing expedition. Healthcare data breaches continue to ... Read more
How to Recognize Phishing
The Federal Trade Commission (FTC) defines phishing as “an unexpected email or text mess... Read more
Reader Questions:
Define Treatment Goal, Determine MDM Stability Calculation
Question: A patient with chronic pain presents for an evaluation and management (E/M)... Read more
Reader Questions:
Apply SDOH Codes for Underdosing and Financial Insecurity
Question: During a recent follow-up appointment with an established patient, the pati... Read more
Reader Questions:
Heed These Changes for Accurate HIPEC Coding
Question: How do I code hyperthermic intraperitoneal chemotherapy (HIPEC) after cytor... Read more
You Be the Coder:
Code for Context in This Adverse Chemo Effect Scenario
Question: A patient experiences throat pain from vomiting following chemotherapy. In ... Read more
ICD-10-CM Coding:
Perfect Your Ovarian Cancer Coding With This Guide
Remember to keep these ovarian cyst codes handy, too. On the surface, coding for malignan... Read more
Mythbuster:
Bust These 3 Myths for Accurate PSA Test Coding
Here's how to connect screens and diagnostic tests with medically appropriate dx. There a... Read more
Practice Management:
Use This Expert Advice to Fine Tune Your CDI Process
Learn how to make your queries effective. If you've been neglecting your clinical docume... Read more
Reader Questions:
Count Fractions the Medicare Way for Radiation Treatment Management
Question: I know that I should bill 77427 for five treatments. My question is this: ... Read more
Reader Questions:
Know How to Support These Immunodeficiency Codes
Question: What kind of support is needed to report D84.821? Do I need to see an immun... Read more
Reader Questions:
Code This Lymph Node Path Report as Secondary
Question: One of our patients had known invasive ductal carcinoma of the breast and ... Read more
You Be the Coder:
Read This Add-On Descriptor to Code Sentinel Node Biopsy Correctly
Question: When one of our patients is sent for a sentinel node biopsy, the patient fi... Read more
Diagnosis Focus:
Up the Ante on Your Anemia Coding
Here's how to navigate all the associated condition codes. Look up anemia in the ICD-10-... Read more
Learn the 4 Main Forms of Anemia
According to the National Heart, Lung, and Blood Institute (NHLBI), there are four main ty... Read more
E/M Coding:
Follow 5 Tips to Solidify Inpatient Care Coding
Stay on top of the hospital E/M revisions. For the last year, you have been using a revis... Read more
Modifiers:
Remember These Modifier 22 Dos and Don’ts
Beware of falling into the unlisted code trap. Consider this scenario: Your oncologist d... Read more
Reader Question:
Don’t Split These Chemo Components
Question: I bill for an outpatient service department at a local hospital, and when p... Read more
Reader Question:
Be Suspicious of Suspected Diagnoses
Question: Our providers are notorious for using “consistent with” and “likely... Read more
Reader Question:
Look to This LCD for Breast Reconstruction Necessity
Question: I billed 19318-RT for symmetry with 19361-LT for breast cancer and absence ... Read more
You Be the Coder:
Avoid Confusion With This Chemo Infusion Scenario
Question: Do I need a modifier to bill 96413 and +96368 together on the same date of ... Read more
Oncology Coding:
See How These 2025 CPT® Code Changes Will Impact Your Oncology Practice
Get a handle on these sweeping changes before the New Year arrives. Oncology practices ac... Read more
Oncology Coding:
Know Your Options in Pump Disconnect Scenarios
Question: I need some help on the issue of pump disconnects. Specifically, what if you hav... Read more
Oncology Coding:
Assign Signs and Symptoms Dx for This Free Light Chains Test Result
Question: A patient had a lab come back showing elevated light chains. The oncologist indi... Read more
Oncology Coding:
Use These Keys to Unlock Breast Cancer Coding (Part 1)
Understand these core codes and how to apply them. Breast cancer coding may seem simple o... Read more
Oncology Coding:
Don’t Rise to Definitive Dx in This Elevated PSA Scenario
Question: We have a patient that had prostatectomy, and their prostate-specific antig... Read more
Oncology Coding:
Prepare to Be Puzzled by This Polycythemia Phlebotomy Problem
Question: Our oncology surgeon did a therapeutic phlebotomy in a patient with polycyt... Read more
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