07/18/2023

ASCO Coding Tip of the Month: July 2023

ASCO Coding Tips of the Month
When the patient is presenting for chemotherapy, immunotherapy, or radiation therapy, the primary diagnosis code should be an encounter code which reflects the therapy the patient is receiving at that encounter.

Example: Z51.0 Encounter for antineoplastic radiation therapy Z51.11 Encounter for antineoplastic chemotherapy Z51.12 Encounter for antineoplastic immunotherapy 

If the patient is presenting for a follow-up after the treatment has been completed, the provider would report the correct encounter for the follow-up diagnosis code as primary. 

Example: Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm 

In addition to the primary diagnoses above, the appropriate diagnosis codes related to the conditions requiring care would also be reported for the services provided.

Coding Tip of the Month: New patient vs. Established
New patients are defined under CPT guidelines as not having received any face-to-face services from the physician or other qualified health care professional of the same specialty and subspecialty who belongs to the same practice group within the past three years. Advanced practice providers and covering providers are considered the same specialty and subspecialty as the physicians they are working with.

Practice location does not affect this definition. If the provider changes practices and the provider OR another provider of the same specialty in the new group has provided any professional services to the patient within three years, the patient would be considered established.

Payers may have their own guidelines; therefore, it will be important to check their policies.