A Valuable Resource for Oncology Practices

Dawn Holcombe, MBA, FACMPE, ACHE
President, DGH Consulting, South Windsor, CT

We are pleased to present this 2021 Oncology Drug Coding and Updates special feature, designed to provide you with helpful information on the topic of oncology drug coding and important details on some of the drugs now available to treat patients with cancer. The COVID-19 pandemic led to many changes in patient care and treatment choices for oncology practices. Flexibility and innovation regarding both oral and infused/injected drugs became key to ensuring patient access to necessary treatments.

Accurate coding of services is essential to the financial stability of oncology medical practices and the effective care of patients. This requires careful collaboration and communication among team members to ensure appropriate documentation of the services that have been performed. Because the details and nuances of oncology coding for oral and office-administered drugs change frequently, it is vital to have accurate information available to all members of the practice.

Valuable resources are expended every time members of an oncology practice interact with a patient (or act on behalf of a patient). These resources must be quantified in terms of time, products, information gathering, and services. Each patient encounter requires documentation that must be carefully processed and tracked. Oncology practices must provide details such as the type of care provided and the kinds of supplies used, so that payers can be confident that they are paying for actual services rendered. There are serious consequences related to inaccurate coding and documentation, including errors in the patient’s medical history (which can potentially endanger the patient) and failure to receive appropriate payment for services (which can affect the financial stability of the practice over time).

Proper drug documentation and coding are particularly critical in oncology because of the variability of vial sizes, dosages for patients, units of measurement (which may vary between administration and allowed billing units), manufacturers, and coverage. The clinical staff must understand the codes and their parameters to provide appropriate documentation for the medical record and to support the codes that are used to bill for the services.

We hope that you find this resource to be a valuable asset to your practice as you provide essential care to your patients.

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