Oncology & Hematology Coding Alert

Here’s why 99199 can be confusing.

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

You, as the coder, have a tricky situation. 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 as a guide for steps 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 if occurring frequently and/or if it is worth pursuing.

Keep in mind:  Your practice’s responsibility is to help members of the community. However if no-shows are financially hurting your practice, then, no matter the circumstances, the office should determine how you can take action and preserve its 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, the office 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 missed appointments. The first thing you must do is verify there is a policy and understand the content completely. If a policy does not exists, the practice would have little support to enforce a consequence if questioned.

If no policy is currently in place, pay close attention to specific circumstances that may apply. There may be situations when missing an appointment isn’t billable (such as, if a patient cancels with an acceptable amount of notice prior to the appointment). For example, if the policy states canceling the visit at least 24 hours in advance is required and the patient does, charging a fee for the missed appointment would not be appropriate since enough advance notice was given. 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 the patient for no-shows under certain conditions. The first condition is, rules must be clearly stated in an office’s policy that no-shows are charged and under what circumstances. The second condition is that this policy is universal, and all patients are subject to the same rule and charge and no individual, group, or patient type are exempt.

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 supplies. 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 more for more those requiring greater amounts of blocked time or supplies specifically ordered to render the scheduled service(s).

Step 3: Know Whom to Bill

If the office has determined it will pursue a billing program for no-shows and the policy clearly states the terms, you must now know who to bill. For situations like these, DO NOT bill the payer, the practice may only bill the patient.

Payers may only be charged for rendered medical services and/or supplies utilized on the patient. No-show fees, are not medical services were performed and therefore, the payer cannot be billed.

“When I was a practice manager, we never billed” for situations like this, says Judy Klobutcher, BSN, MBA, CPC, coding specialist at nThrive in Ashland, Ohio.

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 and perpetuated over the years because of the code definition vagueness. Offices often set up an internal charge code with a description of the charge that generates on the patient’s bill.

Tip: No one likes to lose patients. However, patients who consistently miss appointments can result in practice financial liability. If the problem reaches a significant percentage of your patient base it may be in the practice’s best interest to terminate the relationship. 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.

For instance, “we sent letters and after three no shows, we dismissed” the patient “from our practice. If they were never seen by our practice, we didn’t make any more appointments and notified the referring provider (if there was one),” Klobutcher says.