Understanding Oncology Medical Billing

Oncology medical billing is a complex system of coding for cancer treatment. Accurate medical billing is essential in oncology medical billing practices. It is not just for administrative purposes but also for ensuring patient satisfaction. With a growing emphasis on value-based care, coding errors or incomplete documentation can result in denied claims. These issues can impact the financial sustainability of the practice.

Oncology medical billing is considered a comprehensive coding system for cancer treatment because it involves detailed medical coding and documentation to ensure healthcare professionals receive timely reimbursement for cancer treatment services. This specialized branch of medical billing takes into account the unique challenges that come with treating cancer patients. These challenges include the use of costly diagnostic tests, chemotherapy, and radiation therapy.

That is the reason it requires a deep understanding of medical terminology and Oncology medical billing codes. It also requires a commitment to remain up to date with changes in healthcare regulations and insurance policies. Cancer patients and their loved ones specifically depend on the expertise of trained oncology medical billers. They depend on them to help them deal with the financial complexities of cancer treatment and ensure they can access care and reimbursements.

Major Oncology Disciplines

Oncology medical billing is the field of medicine that deals with the diagnosis, prevention, and treatment of Cancer. It deals in several specialized areas. These include Surgical Oncology, Radiation Oncology, and Medical Oncology.

Surgical Oncology

Surgical oncology plays an imperative role in healthcare. These include cancer prevention, cancer diagnosis and staging, curative surgery, tumor reduction, and supportive procedures. Surgical Oncology focuses on using surgery as a treatment method for Cancer. It also deals with palliative surgery to relieve cancer symptoms and reconstructive surgery to restore the appearance and function of affected body parts. Surgical oncologists perform procedures to remove cancerous tumors and assess the extent of damage that Cancer has made. They work closely with primary care physicians to develop treatment plans and conduct diagnostic biopsies.

Radiation Oncology

Radiation Oncology is a medical discipline that uses radiation therapy for cancer treatment. This therapy involves the use of X-rays to destroy or shrink tumors. Radiation therapy can be used as a primary treatment or it can also be used in conjunction with other treatments. It may be used before or after surgery to reduce tumor size and inhibit cancer cell growth.

There are number of other objectives of using radiation therapy. For instance, it includes curing Cancer, halting the growth and spread of cancer cells, reducing tumor size, supporting other cancer treatments, and alleviating cancer symptoms. However, radiation therapy may have side effects as well. For instance, the major side effects include damage to normal cells, fatigue, skin issues, mouth or throat discomfort, breathing difficulties, nausea, loss of appetite, and cough.

Medical Oncology

Medical Oncology is a specialized field that addresses cancer diagnosis, prevention, and treatment by using various modalities. These include chemotherapy, targeted therapies, hormonal therapy, immunotherapy, and more. Medical oncologists often serve as primary care physicians for cancer patients. Medical oncologists are responsible for supervising entire treatment plans, collaborating with other specialists, and monitoring patient responses.

CPT Codes for Oncology Medical Billing And Claim Submission

Planning and Simulation Codes

• 77261: This code is used for simple treatment plans that focus on the tumor and require minimal blocking.
• 77262: This code is used when planning involves moderate complexity, like multiple treatment areas or special requirements.
• 77263: This code is Similar to 77262 but for moderate complexity planning.
• 77280: This is for simple simulation, which is like practice for a single treatment area.
• 77285: This code is for more complex simulation involving two separate treatment areas.
• 77290: This code is used for very complex simulations. It involves multiple treatment areas and special techniques.
• 77293: This is an extra code for simulating treatment during breathing motion.

Treatment Planning Codes

• 77295: This code is used for creating 3D treatment plans that include detailed dose-volume information.

Special Port Plans and Dosimetry Codes

• 77321: This code is used for special tele therapy port plans, particles, or hemi-body treatment.
• 77331: This code is used for special dosimetry, like measuring radiation doses with changing frequency.

Codes for Treatment Devices

• 77332: This code is used for simple treatment devices and designs, including basic blocks and bolus.
• 77333: This code is used for Oncology medical billing the intermediate treatment devices that involve multiple blocks and special bolus.
• 77334: This code is used when you have complex treatment devices. It includes custom molds and immobilization devices.

 Consultation Codes

• 77336: This code is used for general consultations to assess treatment parameters and quality assurance.
• 77370: This code is used for special consultations when unique situations arise during radiation therapy.

Intrafraction Tracking Code (OPPS only)

• 77387: This code is used when radiation treatment involves tracking during the treatment itself. It is imperative to note that it is only used in a specific payment system (OPPS).

Radiation Treatment Delivery Codes

• CPT Codes 77401-77416: These codes recognize the technical component of the procedures. However, they do not represent the work of physicians.

Radiation Treatment Delivery Codes

• 77401: This code is used for superficial or orthovoltage radiation treatment per day.
• 77402: This code is used for simple radiation treatment delivery with minimal complexity (OPPS only).
• 77407: This code is used for intermediate treatment delivery involving multiple ports or blocks (OPPS only).
• 77412: This code is used for complex treatment deliveries that require custom blocking and special techniques (OPPS only).
• 77417: This code is used for reporting verification images during treatment.
• 77470: This code Covers additional physician effort for special treatments like total body irradiation.  Read More...