Navigating Oncology Billing: Common CPT Codes Explained

Navigating Oncology Billing: Common CPT Codes Explained Untitled Part 1

Oncology billing is a comprehensive process that involves a myriad of complex CPT codes. Applying inaccurate immunology CPT codes can cause your practice to experience consequences like claim denials, payment delays and finally revenue leakage. Most oncology practices lose a substantial amount of revenue because of coding errors. However, you still can avoid coding mistakes in the immunology billing process by knowing about the frequently used CPT codes mentioned below-

Evaluation and Management (E/M) codes:

You should use E/M codes for describing the visit and consultation with oncology patients. Based on the patient history that you have obtained, physical exam performed and medical decision, you should perform the code selection. The frequently used E/M codes are-

• 99201-99205: New patient visit in an office or outpatient setting

• 99211-99215: Established patient visit in an office or outpatient setting

• 99241-99245: Consultation in an office or other outpatient setting

• 99354-99355: Prolonged services involving direct patient contact

For providing additional details, sometimes you may need to use modifiers 25 and 57.

Chemotherapy administration codes:

• 96409 – Chemotherapy administration, intravenous infusion technique

• 96411 – Chemotherapy administration, intravenous push technique

• 96413 – Chemotherapy administration, intravenous infusion technique requiring pump

• 96415 – Chemotherapy administration, intravenous infusion technique; each additional hour

• 96417 – Chemotherapy administration, each additional sequential infusion (different drug/substance)

You should report additional drugs, sequential infusions, and prolonged administrations separately.

Chemotherapy drug codes:

You should always use J-codes for reporting drugs used in chemotherapy.

Some of the common codes for chemotherapy drugs include:

• J9000-J9999 – Chemotherapy drugs

• J0640 – Leucovorin calcium injection

• J0897 – Denosumab injection

• J9015 – Aldesleukin injection

• J9299 – Injection, trastuzumab, 10 mg (Herceptin)

Medical oncology services:

Medical oncology includes services like treatment planning and care management and commonly used medical oncology codes include:

• 96400 – Chemotherapy administration, complex, requiring prolonged physician contact

• 96401 – Chemotherapy administration, complex, requiring prolonged physician contact; each additional hour

• 96402 – Chemotherapy administration, each additional intravenous drug

• 96405 – Chemotherapy administration into a central vein

• 96406 – Chemotherapy administration into a completely implantable pump

• 96408 – Chemotherapy administration into a surgically implanted catheter

• 96416 – Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours)

• 96425 – Chemotherapy administration, intra-arterial; push

• 96440 – Chemotherapy intrathecal; without preservative

• 96446 – Chemotherapy intrathecal; with preservative

• 96521 – Refilling and maintenance of portable pump for chemotherapy

• 96522 – Refilling and maintenance of implantable pump for chemotherapy

• 96523 – Irrigation of venous access device for chemotherapy

Radiation oncology services:

CPT codes for radiation oncology services report radiation planning, simulation, and physics services to deliver radiation therapy.

• 77300 – Basic radiation dosimetry calculation

• 77261 – Therapeutic radiology treatment planning; simple

• 77262 – Therapeutic radiology treatment planning; intermediate

• 77263 – Therapeutic radiology treatment planning; complex

• 77280 – Therapeutic radiology simulation-aided field setting; simple

• 77295 – 3-dimensional radiotherapy plan

• 77332 – Stereotactic radiation treatment management

• 77334 – Stereotactic body radiation therapy

• 77427 – Radiation treatment management, 5 treatments

• 77431 – Stereotactic radiation treatment management

• 77432 – Stereotactic body radiation therapy management

These are just some of the commonly used oncology codes but there are many other CPT, HCPCS and ICD-10 codes that you need to take care of when handling oncology billing. To navigate the complex coding affair, most oncology practices outsource their entire oncology billing and coding jobs to professional third-party billing companies. Outsourcing enables you to fully focus on patient care, save a substantial amount of costs and ensure operational excellence.

If you're looking for a dependable oncology billing and coding partner, Sunknowledge is an excellent choice. As a top RCM company in the nation, Sunknowledge has established efficient billing systems for hundreds of radiology practices. For more information about their comprehensive oncology billing and coding solutions, speak with one of their experts today.