Oncology & Hematology Coding Alert

Key: Code 99199 Can Be Confusing

A patient is scheduled for a consultation but they never show up for the visit. That means your oncology practice misses out on time and money.

You, as the coder, have a tricky situation in front of you. There is a lot of misinformation about what to do in these scenarios and the last thing you want is to incorrectly report because of bad information. Read on to guide yourself through the steps to accounting for this circumstance.

Step 1: Determine the Extent of the Problem

Every practice is different. Some practices work with communities who cannot afford additional charges. In this case, it is important to see how widespread of a problem no-shows are, and determine if it is worth pursuing.

Keep in mind: Your practice’s responsibility is to help members of the community. If no-shows are financially hurting your practice, then, no matter the circumstances, you and the oncologist should determine a course of action that preserves your mission.

Tip: Consider giving out a free missed appointment if you are concerned about the financial state of your patients. If a patient misses one appointment, you and the head oncologist can work out a system where a letter is sent reminding that any further missed appointments will result in a fee. This is a good way to warn patients about the consequences of no-shows while being sensitive to their situations.

Step 2: Evaluate Your Policy

Every practice has their own policy about whether they should charge for patients not showing up for an appointment. The first thing you must do is to double- check with the head oncologist regarding the official language of the policy. If nothing is written down to reference no-shows, then the practice has little support to enforce it should the practice be questioned.

If your practice does have a policy in place, pay close attention to specific circumstances that may apply. There may be situations when missing an appointment isn’t billable. For example, if a patient cancels 24 hours before their appointment and the policy states canceling (one l) the visit more than 24 hours in advance is required, the no-show is no longer a no-show visit because notice was given with enough advance notice. Or, in some cases, policies may say scheduled consultations can be billed if no cancellation is received within a certain timeframe.

Note that Medicare does allow practices to charge for no-shows under certain conditions. The first condition is that, as mentioned previously, the rules must be clearly stated in an office’s policy that no-shows can be charged and when. The second condition is that this policy is universal, meaning that all patients are subject to the same policy and no individual is exempt.

If there is still confusion, you can always resort to checking state laws. Sometimes, states have guidelines about what is billable and what is not.

Tip: Some appointments are considered less severe than others. For example, a consultation is considered lower tier than a procedure where the oncologist had to order special parts. A good idea is to rank your no-show fees based on the nature of the appointment. Typically, you can bill lower costs for lower-tier appointments and work your way up for more serious appointments.

Step 3: Know Whom to Bill

If you and the oncologist have determined that you will pursue a billing program for no-shows and your policy clearly states that you are able to do so, you must now know who to bill. A fallacy among coders isthat for situations like these, you bill the payer. This is incorrect.

For no-shows, the practice must bill the patient, not the payer.

The reason for this is because the payer can only be charged for medical procedures. No-shows, by their nature, mean that no medical procedures were performed and therefore, the payer cannot be billed.

Be careful: Some coders have suggested in the past that you can use code 99199 (Unlisted special service, procedure, or report). This is a myth that has been perpetuated over the years due to the vagueness of this code definition. This is not the code to use. Again, because no medical procedure or consultation occurred, the patient must be directly billed.

Tip: No one likes to lose patients. However, if a particular patient consistently misses his appointments, it is in the practice’s best interest to release this individual from the patient list. As long as the etiquette is clearly outlined in the policy, an office can decide to refuse a patient after a certain number of no-shows.