Oncology & Hematology Coding Alert

Tip: Increase the E/M level for ordering of report

When the oncologist order x-rays, the codes you choose depend on whether your physician owns the x-ray equipment. Follow this expert advice to ensure you get paid ethically for your physician's x-ray services.

Add X-Ray Orders to the E/M Level

If your oncologist wants compensation for ordering or reviewing a patient's x-ray films, you may be able to bill a higher E/M level, says Mary Ann Luick, CPC, CCP, a coding and compliance professional at UPMC Cancer Centers in Pittsburgh.

Remember: Most radiologists write reports for every patient, coding experts say. When a patient presents to an oncologist with only the x-ray films in hand, the patient probably forgot to bring the report, or the patient's primary-care physician (PCP) failed to forward the report to the oncologist.

For instance, a woman with a cough (786.2) and bloody sputum (786.3, Hemoptysis) presents to your oncologist, but she brings only the x-ray film, not the radiologist's written report. The oncologist requests the patient's missing report, interprets the films as lung cancer (162.x, Malignant neoplasm of trachea, bronchus, and lung), and develops a treatment plan.

The lowdown: Because your physician ordered the records, he can receive credit for this in the "amount and/or complexity of data ordered/reviewed" category of medical decision-making, Luick says.

The oncologist can add one point to the E/M service's decision-making level for the decision to obtain records. He can add two points for the independent visualization of the films. Ordering records satisfies one of the two categories required for reporting moderate-complexity decision-making -- a key component for 99204 (Office or other outpatient visit for the evaluation and management of a new patient ...). And, if you report 99204 to Medicare, you can expect $140.
 
You Can Report X-Ray and E/M

When the oncologist owns x-ray equipment and interprets the results, you should report the full radiological code. For example, if the oncologist took an x-ray of the lung cancer patient, you could report 71020 (Radiologic examination, chest, two views, frontal and lateral).

"We report 71020 and the E/M code," says Andrea Pafford, billing manager at Family Cancer Center in Collierville, Tenn. Most patients present to the oncologist for a follow-up visit, and during the visit the physician decides to take x-rays, she says.

Use this tactic: If you want to get paid for 71020 and an E/M code (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...), you should append modifier -59 (Distinct procedural service) to 71020, Pafford says.