Wiki Surgical Oncology coding

[LDEPASS]

We do the billing and coding for a surgical oncologist and they send us the op report and the prior authorization showing what CPT codes are approved and expect us to code from this. Can someone direct me where to find info stating the biller must use the codes checked off on a fee ticket by a coder or the physician, and not a pre auth form from the medical receptionist.

 

[sbicknell]

I can't refer you to a guideline in writing but look at it this way.....

Unless the medical receptionist has seen the op report and is a certified coder, I don't really care what codes she writes down.

If the Oncol office is sending you the op report and a marked fee ticket, then that is what is coded (assuming the fee ticket codes are supported by the Op report)

The fact the Oncol is also sending the prior authorization of what CPT codes were pre-author is irrelevant. Coding is not assigned based on what was authorized. The issue for reimbursement will be if XXXX was pre-authorized but the physician did ZZZZ. The payer can and will most likely deny payment for no pre-auth for the billed ZZZZ surgery

You say your office is doing the billing and coding, then regardless of what codes the physician/coder marked on the fee ticket and regardless of what was pre-authorized, the coding is assigned based on the final OP report.

I suggest that if a code change was made, the Oncol physician be notified so everyone is aware and agrees what codes are being billed and it will also provide education on either his end or on your end