Billing in Oncology/Hematology

[humd2010]

I have some questions regarding billing for the seasoned Oncologists/Hematologists on here. I worry that I might be under-billing. I typically bill a level 5 for a new Onc patient, a level 5 when I’m changing the chemo regimen, a level 4 for routine chemotherapy visits, and mostly level 3s for surveillance visits (labs and imaging). Should I be billing level 5s for chemo visits (they are very toxic drugs requiring close monitoring, right?) and level 4s for surveillance visits?

Hematology is even worse with lots of labs and less imaging. What do you do here?

What are the wRVU values for each level of service (outpatient Oncology and Hematology) and what’s a good resource to learn more about this?

I appreciate your insight.

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[gutonc]

The first thing to do is go over some recent charts/billing with you billing/coding people. Ask them to analyze a week of your charts and see how's it going.

Next step is to ask what your partners are doing.

I generally do what you're doing more or less. For the heme patients, I'm usually billing on time.

 

[humd2010]

Thanks for your reply. Much appreciated.

 

[gutonc]

Also, the wRVU values are fixed so don't stress about that. Just remember that you can make more billing 3-4 99214s an hour than you can doing 1 99205.

A straightforward chemo follow-up with no significant SEs (like the guy I saw today on single-agent Gem for the past 6 months w/ good response to treatment and no SEs) is a 99213. Throw in 1 treatment or disease related SE (CINV) and it's a 99214. Add 1 more thing and you're at a level 5. it's really not that difficult.