Oncology billing question

[osprey099]

I'm only a fellow but currently rotating in some of my attendings' outpatient clinics. They pretty much told me to click 99214 or 99215 for every oncology patient that comes through.

If on chemo, then 99215
If just monitoring, then 99214

Will this be a good general rule of thumb for the future practice I join as a new grad? This seems much simpler than the complex billing guidelines we had to follow for our internal medicine residency clinic patients (x number of ROS and y number of problems = 99213/4/5 etc)

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[gutonc]

I'm only a fellow but currently rotating in some of my attendings' outpatient clinics. They pretty much told me to click 99214 or 99215 for every oncology patient that comes through.

If on chemo, then 99215
If just monitoring, then 99214

Will this be a good general rule of thumb for the future practice I join as a new grad? This seems much simpler than the complex billing guidelines we had to follow for our internal medicine residency clinic patients (x number of ROS and y number of problems = 99213/4/5 etc)

If documentation supports it, sure. But you should probably put a little more thought into it than that.

For me, the general rule is:
- Clearly just observation with completely normal labs/imaging = 99213
- On any treatment (chemo, endocrine, IO, whatever) with literally no side effects = 99214
- On treatment or not but with significant treatment or disease related side effects/symptoms requiring intervention = 99215

My personal breakdown is about 25/40/35 for the 3.

 

[HemeOncHopeful19]

OP, IIRC the billing requirements have changed significantly no more HPI or ROS requirements so you are only billing based on medical decision making/complexity.

In Oncology that ends up with the general rule of thumb of “on treatment = level 5, not on treatment = level 4” that your attendings mentioned but like GutOnc mentioned I’ve seen a lot of those surveillance H&P patients end up being 3s.

 

[MD46]

I mean if patient on chemo has low ANC or platelets requiring holding of chemo that should be level 5
However if same patient is having nausea with chemo and you had compazine to zofran or up the dose of zofran that should be a level 5 as well, no?

 

[gutonc]

I mean if patient on chemo has low ANC or platelets requiring holding of chemo that should be level 5
However if same patient is having nausea with chemo and you had compazine to zofran or up the dose of zofran that should be a level 5 as well, no?

Correct in both cases, which is consistent with my rubric. I definitely bill more on time these days since they changed the F2F requirements though.