Oncology & Hematology Coding Alert

Demonstrating cost savings could be your key to reimbursement

Are you ready to throw in the towel when it comes to reporting radiation oncology procedures that don't have specific codes? Reporting an unlisted-procedure code doesn't have to mean a denial. Cut time off of your unlisted- procedure claims by following these hints on how to get them right the first time.

Remember: CPT guidelines tell you never to choose a code that merely approximates the service provided. Instead, good coding practices require you to report an unlisted-procedure or -service code.

Check This Chart for Your Procedure

Once you've decided that an unlisted procedure is your best option, review your available unlisted-procedure codes and choose the most appropriate one:

Follow These Tips to Head Off Denials

Claims reviewers don't always keep up with the latest technology (or understand traditional methods), so your best bet is to send documentation along with your unlisted-procedure claim that will convince the payer that your claim deserves reimbursement.

Stick to this plan for better unlisted-procedure claims, based on suggestions from Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and AAPC National Advisory Board president, during her presentation " 'Special' Radiation Oncology Services" at the 2005 AAPC national conference in Salt Lake City.

1. Offer a detailed description of the procedure performed. Couch this in layman's terms - your reviewer may not be familiar with radiation oncology.

2. Include copies of articles in medical journals supporting the reasonableness of the procedure, such as clinical trials and medical indications.

3. Retain documentation of medical necessity to back the decision for the procedure.

4. Explain the time, effort, and equipment required to perform the procedure, both to help the reviewer understand the procedure and to support the amount of reimbursement you request.

5. Remember to submit the patient's indications - diagnosis, chief complaint, presenting signs and symptoms, and any concurrent problems the patient has that require treatment or management.

6. Describe the patient's follow-up care and prognosis to help bolster the argument for medical necessity.

7. Relate the procedure performed to an existing procedure as support for reimbursement. (And explain how your procedure differs to show why you didn't choose the existing code.)

8. Never underestimate the power of demonstrating cost savings from the procedure you chose. If you can illustrate how your procedure will cost the payer less in the long run than the typical course of treatment, your payer should accept your unlisted procedure.