What is Oncology Medical Billing

Touseef Riaz

June 8, 2022

medical oncology billing services

Oncology is the field of medicine dealing with the diagnosis, prevention, and treatment of cancer. It is by far one of the most stressful and complex fields of medicine. Oncology consists of several fields; medical oncology, surgical oncology, and radiation oncology. 

Prevent claim denials in Oncology medical billing

Oncologists are dealing with comprehensive treatment plans, which is the reason why detailed medical documentation is necessary. Proper, accurate, and detailed medical documentation and patient records play a vital role in correct oncology medical billing. Therefore, medical billing, coding, and other administrative tasks can add extra stress to the physicians. Proper oncology billing requires the use of correct and specific codes, following billing and coding guidelines as well as managing the challenges.

Codes and compliance policies of oncology medical billing face several changes frequently. This results in various challenges for the professional staff, e.g., not being aware of the new codes for emerging or the latest technology. Lack of understanding and inadequate knowledge of the procedure and diagnostic codes can result in claim denials hence, lower reimbursements.

oncology medical billing

Along with performing the surgery or treatment procedures, oncology involves other specialists as well. In order to provide quality patient care, oncology also requires dealing with; post-op trauma, mental health, and other medical disciplines. Codes for oncology medical billing are annually updated as well as changes in guidelines, rules, and insurance payers’ requirements. The professionals dealing with medical billing should ensure accurate and correct billing and coding. In case of failure in reporting the correct and updated codes, revenues and payments for services performed are affected. 

Proper medical billing for oncology ensures that the providers and physicians are being reimbursed for the service they performed.

Outsourcing medical oncology billing services:

Due to various challenges faced by oncology medical billing, a rise in outsourcing the billing services have been observed. Outsourcing medical billing for oncology practice can lead to lesser operational and administrative costs and higher revenues. Some of the benefits of outsourcing medical oncology billing services include:

Control over oncology billing:

With the practice of outsourcing, various physicians think that their control over managing the billing process will be limited/lost. However, in reality, outsourcing oncology medical billing comes with several benefits for the healthcare practice. With outsourced billing, a team of professionals looks after the complete medical billing process. They take care of the time-consuming administrative and billing tasks, so you don’t have to worry about it. With an outsourced team of professionals providing you with daily/weekly/monthly reports, you can just sit back and review.

Reduced errors in medical coding:

Medical billing outsourced services companies like UControl Billing have experienced medical billing professionals on board. These oncology medical billing services providers are up-to-date with all the changes in:

  • Codes
  • Coding guidelines
  • Insurance payers’ requirements. 

With this, they ensure to incorporate correct and updated codes as well as use correct modifiers, therefore, reducing errors.  

Streamlined workflow and billing process:

Managing an in-house medical billing team can be pretty hectic and stressful for physicians. Along with that, other challenges like employee vacations, unplanned leaves, and training sessions are also associated with the in-house billing team. There’s a huge dependency on the billing staff, and in case any employee/personnel leaves, your billing gets affected directly. It includes tasks like eligibility verification, charge entry, management of account receivables, etc.

However, on the contrary, with outsourced oncology medical billing services, your healthcare practice gets an entire team of professionals. These trained individuals oversee your billing process and ensure that the medical claims are processed and submitted accurately. Moreover, this team of professionals has vast knowledge and tips on medical oncology billing and is up-to-date. Therefore, ensuring lesser claim denials and faster payments.

Higher revenues and reimbursements:

Oncology is the field of medicine that involves high-cost procedures. This is the reason why even losing one claim can result in a huge loss of revenues and reimbursements for the provider. However, the outsourced team of billing professionals ensures that clean claims are being submitted. These experts in oncology billing recognize the issue, rectify and reduce the time required for receiving reimbursements via effective policies. Lesser errors in medical billing result in lesser claim denials or rejections, faster payments, and a higher reimbursement rate.

By outsourcing oncology billing, not only are your revenues increased but your expenses are also reduced. Your healthcare practice no longer has to bear costs like:

  • In-house employee(s) or team salaries
  • Benefits
  • Computer equipment
  • Billing software purchase and maintenance, etc.

More focus on the patients:

With outsourced oncology billing services, physicians can focus more on providing safe and quality patient care and worry less about revenues. Moreover, they won’t even have to manage the in-house medical billing team, meaning they can spend more time with the patients. The outsource billing team streamlines your workflow and cash flow by submitting clean claims and managing any denials or rejections effectively.

ICD-10-CM Codes for Oncology Medical Billing:

Chapter 2: Neoplasm of ICD-10-CM coding comprises codes for oncology. This chapter ranges from C00 to D49, with a wide range of codes with grouping at a broad level involving malignant, benign, or behavior, etc. Some of the most commonly used ICD-10-CM codes for Oncology include:

C16 – ICD 10 CM code for Malignant neoplasm of the Stomach

C16.0 Malignant neoplasm of cardia

C16.1 Malignant neoplasm of the fundus of the stomach

C16.2 Malignant neoplasm of body of the stomach

C16.3 Malignant neoplasm of the pyloric antrum

C16.4 Malignant neoplasm of the pylorus

C16.5 Malignant neoplasm of the lesser curvature of the stomach, unspecified

C16.6 Malignant neoplasm of the greater curvature of the stomach, unspecified

C16.8 Malignant neoplasm of overlapping sites of stomach

C16.9 Malignant neoplasm of the stomach, unspecified

C43 – ICD 10 CM Code Malignant melanoma of the skin

C43.0 Malignant melanoma of lip

C43.10 Malignant melanoma of unspecified eyelid, including canthus

C43.11 Malignant melanoma of right eyelid, including canthus

C43.12 Malignant melanoma of left eyelid, including canthus

C43.31 Malignant melanoma of the nose

C43.4 Malignant melanoma of the scalp and neck

C43.51 Malignant melanoma of anal skin

C43.52 Malignant melanoma of skin of the breast

C64 – ICD 10 CM Code for Malignant neoplasm of kidney, except renal pelvis

C64.1 Malignant neoplasm of right kidney, except renal pelvis

C64.2 Malignant neoplasm of left kidney, except renal pelvis

C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis

C67 – ICD 10 CM code for Malignant neoplasm of bladder

C67.0 Malignant neoplasm of trigone of the bladder

C67.2 Malignant neoplasm of the lateral wall of the bladder

C67.3 Malignant neoplasm of the anterior wall of the bladder

C67.5 Malignant neoplasm of the bladder neck

C67.8 Malignant neoplasm of overlapping sites of bladder

C67.9 Malignant neoplasm of bladder, unspecified

ICD-10-CM Codes for Benign Neoplasms

D10 Benign neoplasm of mouth and pharynx

D10.2 Benign neoplasm of floor of the mouth

D10.4 Benign neoplasm of tonsil

D14.0 Benign neoplasm of the middle ear, nasal cavity, and accessory sinuses

D24 Benign neoplasm of breast

D24.1 Benign neoplasm of the right breast

D24.2 Benign neoplasm of the left breast

D35.1 Benign neoplasm of the parathyroid gland

D35.2 Benign neoplasm of the pituitary gland

D35.6 Benign neoplasm of aortic body and other paraganglia

D35.9 Benign neoplasm of endocrine gland, unspecified

Z80 ICD-10-CM code for Family history of primary malignant neoplasm

Z80.0 Family history of malignant neoplasm of digestive organs

Z80.1 Family history of malignant neoplasm of trachea, bronchus, and lung

Z80.2 Family history of malignant neoplasm of other respiratory and intrathoracic organs

Z80.41 Family history of malignant neoplasm of ovary

Z80.6 Family history of leukemia

Z80.7 Family history of other malignant neoplasms of lymphoid, hematopoietic, and related tissues

Z80.8 Family history of malignant neoplasm of other organs or systems

What is Oncology?

Oncology is the field of medicine dealing with the diagnosis, prevention, and treatment of people suffering from cancer. It includes several types:

– Medical Oncology

– Radiation Oncology

– Surgical Oncology

– Preventative Medicine

Surgical Oncology:

This type of oncology deals with surgery to treat people suffering from cancer. Surgical oncologists perform surgery to remove the harmful tumors and check if the patient has cancer or whether the condition has affected other organs/parts. These specialists, alongside your physician, design a treatment plan and perform biopsies (a diagnostic procedure) and surgery.

Surgical oncology is either for early-stage cancer or a more advanced stage. There are several reasons behind needing surgical oncology:

  1. Preventing cancer
  2. Diagnosing or checking for cancer
  3. Determining the stage/severity of cancer
  4. Treating cancer
    • Curative procedure
    • Debulking procedure
    • Supportive procedure
  5. Palliative surgery – a procedure to ease cancer symptoms.
  6. Reconstructive surgery – a procedure to restore the look and function of the part affected by cancer.

Radiation Oncology:

Radiation oncology is the field of medicine involving radiotherapy or radiation therapy for treating cancer. Radiation therapy is performed by using X-rays to destroy or shrink the cancer cells/tumor. This approach is one of the most common forms of cancer treatment as the primary treatment or to assist another. Radiotherapy can also be performed before or after the surgery to shrink the tumor in order to stop the growth of cancer cells. It aims to:

  • – Cure the cancer
  • – Stopping the cancer cells from growing/spreading
  • – Shrink their size
  • – Assist other treatments of cancer – used before and/or after the treatment
  • – If cancer can’t be cured by radiation therapy, it is used to reduce the symptoms of the disease.

However, radiotherapy also comes with some side effects, with damage to the normal cells being the most common of all. Some other side effects of radiation therapy include:

  • – Tiredness
  • – Itchy, red, or dry skin
  • – Sore or dry mouth/throat
  • – Shortness of breath
  • – Nausea
  • – Loss of appetite
  • – Cough

Medical Oncology:

This type/specialty of oncology deals with the diagnosis, prevention, and treatment of cancer via:

  • – Chemotherapy
  • – Targeted therapies
  • – Hormonal therapy
  • – Immunotherapy, etc.

Medical oncologists may also act as the primary physician/specialist for some patients. They oversee the entire treatment plan, coordinate with other specialists and monitor the response of the patient.

Common types of cancer:

There are several types of cancer, including:

  • – Anal cancer
  • – Bladder cancer
  • – Blood cancer
  • – Brain cancer
  • – Breast cancer
  • – Kidney cancer
  • – Liver cancer
  • – Lung cancer
  • – Ovarian cancer
  • – Pancreatic cancer
  • – Prostate cancer
  • – Skin cancers
  • – Thyroid cancer

Frequently Asked Questions (FAQs)

1. What is oncology medical billing in medical billing?

Oncology is the field of medicine dealing with the diagnosis, prevention, and treatment of cancer. Proper, accurate, and detailed medical documentation and records play a vital role in correct oncology medical billing. Oncology billing requires the use of correct and specific codes, following billing and coding guidelines, and managing the challenges.

2. What are common oncology medical billing errors?

Errors in oncology medical billing result in claim denials or rejections, ultimately affecting the revenues. Billing codes for oncology are being updated annually, as well as the payers’ requirements and coding guidelines. Use of incorrect or outdated code, incorrect modifiers, late submissions, or incomplete documentation is a common billing error.

3. What does oncology medical billing mean?

Codes and compliance policies of oncology medical billing face several frequent changes. In case of failure in reporting the correct and updated codes, revenues and payments for services performed are affected. Proper medical billing for oncology ensures that the providers and physicians are being reimbursed for the service they performed.

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