Oncology & Hematology Coding Alert

Capture an extra $50 for oncologist-performed volume and mapping Applying a -one-size-fits-all- approach to prostate brachytherapy coding will likely lead you to claims disaster. Instead, you-ll want to approach each case as unique, and carefully identify which of the related -- but separately reportable -- services describing the full course of prostate brachytherapy treatment your radiation oncologist provides. Begin the Process With Proper E/M Selection As with nearly all therapeutic services, your first coding challenge for prostate brachytherapy will be to assign an appropriate E/M service code to describe your provider's initial patient assessment. This initial encounter will typically involve an in-depth, high-level service because the oncologist must evaluate the patient carefully to determine his suitability for brachytherapy and/or to rule out other modalities, such as external beam treatments. At times, the patient will visit the oncologist at the request of a urologist or other specialist. If this is the case, consider a consultation code as your first option. Consultation codes do not differentiate between -new- and -established- patients, but they are dependent upon place of service. For an office our other outpatient consultation, look to 99244 or 99245 (Office consultation for a new or established patient-). For a consultation with an inpatient, check out 99354 or 99255 (Inpatient consultation for a new or established patient). Remember that to meet the requirements of a consultation service, you must have a written consult request from the referring physician that lists the reason for the consultation, says Suzan Berman-Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the department of surgery at the University of Pittsburgh Medical Center. In addition, the oncologist must render an opinion on the patient's condition or suitability for treatment, and he must share this information in a report back to the requesting physician. Use caution: CMS has reported that as many as three-quarters of consult claims fail to meet the minimum requirements for a consultation service, and the Office of Inspector General (OIG) has placed consultation coding at the top of its enforcement agenda for many years running. If documentation does not contain a consult request, along with the reason for that request and the consulting physician's opinion in a report back to the requesting physician, you shouldn't report a consult. Tip: Keep watching Oncology and Hematology Coding Alert for complete instructions on consult reporting. Often, an attending physician will refer the patient to the oncologist for discussion of treatment options with no intention of continuing to treat the patient. In such a case, the attending physician is not requesting a consult, but simply giving a -refer and treat- order. You cannot claim a consult for such an E/M service, Berman-Hvizdash notes. If documentation cannot support a consultation, or [...]