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New ICD-10 Code Set and Oncology Practices

August 12, 2015

New ICD-10 Code Set and Oncology Practices

Our 21st Century has seen advancements in medical technology and healthcare regulations. Together, they have impacted the medical practices and quality of patient care. The oncology practices, too have been impacted, and are a dynamic and challenging area in today’s medical world.

Today’s oncology practice works with patient-facing services with not just medical knowledge but also with much awareness and compassion. This requires time and effort from the attending physician. Thus besides delivering medical care, physicians have a facility to run and for this, revenue cycle management is critical.

With healthcare reforms, new and challenging medical guidelines and changing codes, compliance is becoming a major hurdle to patient care and revenue generation. Moreover, reimbursement for medical and radiation oncology is also under attack by CMS and other payers. In addition to this is the scrutiny by CMS and OIG related to intended or non-intended overpayments, which is all leading to increased costs and risks associated with oncology billing and coding services.

A recent study by the American Society of Clinical Oncology (ASCO), overall demand for oncologist services is slated to be 40%, without the impact of the ACA, with supply growing 25% by 2025. But when the expected impacts of ACA were calculated into the study, an additional 500,000 visits to oncologists were deemed to occur. Is the Oncology medical fraternity up to the challenges that the ICD 10 transition will bring? There does exist some apprehension that initial revenues will take a hit in the first few years as documentation will need to be more intensive, coding errors could occur while one learns what works and doesn’t and payers too will need to understand and get comfortable with specialist coding and billing thereof.

Another impacted area for oncology will be Medicare. Cancer is a disease of mostly the aged, though this is currently undergoing a change. Medicare is responsible for 60-70% of revenues related to cancer care. So when any change occurs, practicing oncologists, be they at hospitals or private practices, decisions to invest in new equipment all depends on a positive return on investment

Certain precautionary measures are advised for oncologists to help maintain a steady revenue cycle:

  • Play close attention to pre authorizations
  • Payer medical Policies
  • Validation of medical necessity denials
  • When documenting- laterality when coding needs to be now coded, including identification of certain diagnoses that need additional coding to further explain symptoms, history of the disease or origin.
  • Careful review of the proposed fee schedule besides specific E&M codes or procedure codes

However, be it in-house or outsourced, proper staff education, proper documentation and effective checks and balances, can help make a successful transition from ICD-9 to ICD-10, and thereby help generate revenues to keep both facilities and patient care quality intact.


Category : ICD-10 Coding