Oncology & Hematology Coding Alert

Oncology and radiation oncology practices can gain additional deserved reimbursement when certain minor surgical procedures are performed on the same day as E/M services. Many coders erroneously believe certain minor surgical procedures are included in the E/M service. To code for both an E/M service and the separate procedure, oncology and radiation oncology practices should be sure they have documented both the medical necessity (the proper diagnosis code) and the separate and distinct nature of the E/M service and the surgical procedure, says Jim Hugh, senior vice president for AMAC, a coding consulting firm in Atlanta.

Services specific to radiation oncologists that can be separately reimbursed in this instance are:

31575 Laryngoscopy, flexible fiberoptic; diagnostic
45330 Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing.
92511 Nasopharyngoscopy with endoscope. "Some practices routinely perform these procedures on patients who come in with throat cancer [149.0], rectal cancer [154.1] or colon cancer [153.0-153.9], but they forget that they should code these procedures separately," says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies, a coding consulting firm in Dallas, Ga. Failing to separate these procedures when appropriate translates to about $80 to $130 in lost revenue per instance. When both the patient visit and the procedure are separately documented and reported, modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be appended to the E/M code (e.g., 99214-25, level-four established patient office visit) to show payers that the patient evaluation was separate and distinct from the surgical procedure. This is the case even though the surgical procedure will have E/M-type services included in the surgical procedure code. By using modifier -25, practices are telling payers that the E/M service was not a part of the preoperative or postoperative care associated with the surgical procedure. In general, Parman says, getting paid for both E/M services and these surgical procedures is a matter of course as long as modifier -25 is appended to the E/M visit and the documentation is in order. The key to documentation is the inclusion of a separate procedure note or a separate paragraph in the patient record detailing the procedure, techniques and findings. A procedure note should be a practice-specific document that is completed by the nurse or physician describing a procedure and its result. It should include an area where the physician signs and dates it. Aside from modifier -25 and documentation, oncology and radiation oncology practices should follow the rules that apply for each procedure as well, Hugh adds. Proving Medical Necessity for 31575 Laryngoscopy (31575) is a method of direct visualization of the larynx by inserting [...]