Medical Coding
Accurate CPT, ICD-10-CM and HCPCS coding, with audits that show where to improve.
About Medical CodingOncology billing and coding
In oncology, a single unit or authorization error can mean a very large unpaid claim. We check drug billing, administration coding and authorization details against each other, because the stakes on each claim are high.
Billing challenges in oncology
Drug units
HCPCS descriptors define the dose per unit, so a calculation error can materially overbill or underbill a drug.
Discarded drug reporting
Single-dose container rules call for modifiers JW or JZ where they apply, along with supporting documentation.
Regimen authorization
A regimen may need authorization for each drug, and changes in therapy may need a new approval.
Off-label use
Payers may review compendia support and clinical records before covering an off-label use, which can lead to appeals.
Codes we commonly review
These are examples, not a full list. Coverage and coding rules vary by payer, so each claim is checked against the current rules and your documentation.
- 96413 chemo infusion, first hour
- 96415 each additional hour
- 96401 chemo injection
- J-codes for drug product
- Modifiers JW and JZ
Services that often help
AR Management
Follow-up on aging claims, backlog cleanup and appeals before filing limits run out.
About AR ManagementHealthcare RCM
The full revenue cycle under one team, from scheduling checks to the final payment.
About Healthcare RCMGet a second look at your oncology billing
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