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Oncology & Hematology Coding Alert

Are Your Denial Records Electronic, Paper ... or Both?

Published on Sat Jan 22, 2005

 J code quandary led one office on a high-tech quest

If your practice received a denial on a claim using the supply code J3490 (Unclassified drugs), would your filing system be updated immediately to reflect the denial?
 
It is not very difficult to track your practice's denials, and experts recommend some sort of tracking system for denials to increase office efficiency.

Tracking System Aids Appeals, Bottom Line

If you track your patient denials carefully, the office can better understand denial patterns and focus its appeals efforts in the most productive areas.
 
On appeals, "I believe that the carriers are trained to look directly for additional information to justify the service or procedure performed on that date of service; it's almost more like a mini-audit," says Audrea Burke, CPC, of Grand Forks Health System in Grand Forks, N.D. Tracking past denials helps Burke's office get ready for a "mini-audit" when preparing an appeal.

Ease of Access to Records Is a Key

When your office's denials are easily accessible, you can review past data on appeals and determine patterns that have led to repeated denials in specific areas, says Rebecca Buegel, RHIA, director of HIM and privacy officer at Casa Grande Regional Medical Center in Casa Grande, Ariz.
 
For example, some oncology offices have trouble proving medical necessity for multiple complete blood count (CBC) tests, which are reported with:

  • G0306 - Complete CBC, automated (HgB, Hct, RBC, WBC, without platelet count) and automated WBC differential count, or
  • G0307 - Complete CBC, automated (HgB, Hct, RBC, WBC; without platelet count), for Medicare patients.
  • 85025 - Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count, or
  • 85027 - ... complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count), for non-Medicare patients.

    If your office has a good tracking system in place, you can note each claim denial in the patient file as soon as possible after the denial is received. Read on for two options to earmark denied claims in your oncology office.

    High-Tech Option: All Digital

    There are several options for keeping tabs on denials in an oncology office. While good old paper files are sufficient, your office might want to consider going digital to track denials.
     
    Take the example of Trilby Foster, CPC, of Blood & Cancer Center of East Texas in Tyler, Texas. Foster's problem is that her office has trouble getting reimbursed for claims using the drug supply codes J9999 (Not otherwise classified, antineoplastic drug) and J3490 (Unclassified drugs). Claims with J9999 and/or J3490 are frequently held up pending medical review, Foster says.
     
    To track claims that use J9999 and J3490, her office's computer system has an "alert note" function, which allows Foster to "add notes to the patient's file if we document a certain procedure is under appeal," she says.
     
    "Most computer software I have seen has the ability to add notes to a patient account. We always place the person's initials beside the note so we can track who is working on the appeal, and the computer automatically dates the note. We then keep a paper file of the appeals," Foster says.

    Low-Tech Options Work as Well 

    If "alert notes" aren't your cup of tea, Foster suggests a simple alphabetical desk file sorter. "It works just as well, and doesn't take up much room," she says.
     
    Whether the record is paper or electronic, the note should include the patient's name, the date of service you're appealing, a brief overview of the appeal, the date you sent it, and all communication to and from the payer.

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