Oncology & Hematology Coding Alert

Remember: You need two of the three key E/M components (history, exam, and medical decision-making) to report subsequent hospital care services. To best support medical necessity, you should document medical decision-making as one of the two components.

If your oncology practice routinely bills the same subsequent hospital care code, you should perform a chart review to ensure you're accurately coding the visits, coding experts say. 

For instance, you take a random sampling of charts in which you reported 99231. You review each file to determine whether the history, exam and medical decision-making levels meet the requirements for 99232 or 99233, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center.

Another possible coding problem is when the physician reports 99233 one day, 99231 for the same patient the following day, and then returns to a 99233 charge the day after, says Kelly Reibman, CPC, a billing representative for an oncology practice in Easton, Penn.

Make sure the documentation explains why the patient's condition necessitated different coding levels.

Of the three E/M components -- history, exam and medical decision-making -- you must fully document two components in a patient's chart to justify use of each subsequent care code, Jandroep says.

The documentation is what counts when you report subsequent hospital care levels, Reibman says. "If there is little or no documentation, then you need to change the code."

Typically, oncologists document the exam and medical decision-making components to fulfill CPT's E/M requirement. If your physician performs high-complexity medical decision-making along with a problem-focused history and exam, you have problem-focused documentation.