Hematology is the medical specialty focused on the diagnosis and treatment of blood disorders, including anemia, leukemia, lymphoma, hemophilia, and clotting abnormalities. Due to the complexity of services provided—ranging from lab diagnostics and biopsies to infusion therapy and oncology-related care—hematology billing demands specialized knowledge of CPT/ICD coding, drug billing, and insurance requirements.

At Progressive RCM, we deliver end-to-end hematology billing services designed to reduce denials, optimize claim submissions, and increase reimbursement — so you can focus on patient care.

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Common Challenges in Hematology Billing

1. High Complexity of Services

Hematologists frequently deal with:

• Complex diagnostic evaluations

• Chemotherapy administration

• Bone marrow procedures

• Infusion and injectable drug billing

• Chronic condition management

This complexity requires detailed coding, modifier use, and payer-specific guidelines to avoid underpayments or denials.

2. Drug and Biologic Billing

Many treatments involve high-cost drugs like erythropoietin, rituximab, or chemotherapy agents. Billing must include:

• Correct HCPCS (J codes)

• Units of service

• Drug wastage modifiers (JW)

• Dosage calculations based on patient weight

3. Coordination with Oncology

Hematologists often share billing with oncology practices. It’s crucial to avoid duplicate billing, especially for E/M and infusion procedures.

4. Medical Necessity and Documentation

Payers require specific ICD-10 codes and supporting documentation to justify tests like bone marrow biopsies or prolonged infusions. Missing information results in payment delays.

5. Prior Authorizations

Due to the costly nature of hematology treatments, insurers often require pre-authorization for diagnostic testing, medications, and procedures.

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Common CPT and ICD-10 Codes in Hematology

✅ CPT Codes:

• 38220 – Bone marrow aspiration

• 38221 – Bone marrow biopsy

• 96365–96379 – Infusion and injection therapy

• 85025 – CBC with automated differential

• 85610 – Prothrombin time (PT)

• 85730 – Partial thromboplastin time (PTT)

• 36415 – Collection of venous blood (routine)

✅ HCPCS Codes (Drugs):

• J0881 – Epoetin alfa injection

• J9312 – Rituximab

• J1439 – Ferrlecit (iron injection)

• J0885 – Darbepoetin alfa

✅ ICD-10 Codes:

• D50.9 – Iron deficiency anemia

• D63.1 – Anemia in chronic kidney disease

• C91.00 – Acute lymphoblastic leukemia

• C85.80 – Non-Hodgkin lymphoma

• D66 – Hereditary factor VIII deficiency

• D68.9 – Coagulation defect, unspecified

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Hematology Services That Require Specialized Billing

• Complete blood count and pathology analysis

• Bone marrow aspiration and biopsy

• Intravenous iron and blood product infusion

• Anticoagulation monitoring and therapy

• Chemotherapy coordination with oncology

• Hemophilia treatment and monitoring

• Molecular and genetic testing for blood cancers

• Chronic disease management for sickle cell or thalassemia

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Our Hematology Billing Services

At Progressive RCM, we understand the unique coding, documentation, and regulatory requirements of hematology. Our services include:

✅ Insurance Verification & Pre-Authorization

• Confirm coverage and eligibility for diagnostic testing and infusion therapy

• Obtain prior authorizations for high-cost medications and outpatient services

• Identify co-payments, deductibles, and benefit limitations

✅ Medical Coding and Documentation Review

• Assign accurate CPT, ICD-10, and HCPCS codes

• Review provider notes for medical necessity

• Apply modifiers such as 25, 59, JW, and RT/LT as needed

• Ensure compliance with NCCI edits and payer policies

✅ Drug Billing and Infusion Documentation

• Calculate drug dosage and units administered

• Report drug wastage using the JW modifier

• Code for initial, subsequent, and concurrent infusions

✅ Claims Submission & Payment Posting

• Submit clean claims within 48 hours

• Post ERA and EOB payments promptly

• Identify and reconcile short pays or missing reimbursements

✅ Denial Management & Appeals

• Analyze root causes of denials

• Correct coding, documentation, or authorization issues

• Prepare and submit timely appeals with supporting records

✅ Patient Billing & Collections

• Generate easy-to-read statements

• Support patients with billing inquiries

• Offer payment plans and online portals

✅ Monthly Reporting & Compliance

• Monitor key KPIs including revenue per patient, denial rate, AR aging

• Ensure Medicare and commercial compliance

• Support your team during payer audits or MAC reviews

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Why Choose Progressive RCM for Hematology Billing?

✅ Specialized Knowledge
Our team includes coders and billers trained in hematology, oncology, and infusion therapy, ensuring accurate and compliant billing.

✅ High-Cost Drug Management
We track and bill J codes, dosage units, and wastage efficiently — ensuring every cent is reimbursed.

✅ EHR & EMR Integration
We work with all major platforms including:

• Epic

• Kareo

• NextGen

• Allscripts

• eClinicalWorks

• Cerner

✅ Improved Collections and Fewer Denials
Our clients see improved first-pass claim acceptance rates, reduced AR days, and faster reimbursements for infusion and diagnostic services.

✅ Chronic and Complex Case Support
We help hematology practices bill for chronic disease management, long-term patient plans, and genetic or specialty testing.

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Key Performance Metrics We Track

• Clean claim rate

• First-pass resolution rate

• Average reimbursement per visit

• Denial rate by code or payer

• Days in A/R

• High-cost drug approval rate

• Missed charge capture (drug units, injections)

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Final Thoughts

Hematology is a high-stakes specialty that demands billing precision, compliance awareness, and a deep understanding of clinical procedures and pharmaceuticals. Even a small mistake in code assignment or drug unit billing can result in thousands of dollars in lost revenue.

At Progressive RCM, we treat your hematology billing with the same care and accuracy you provide to your patients. With our specialty-trained team and data-driven workflow, your practice will see better collections, cleaner claims, and fewer billing headaches.