Hospitals and oncology centers rely on accurate room-and-board coding to ensure clean claims, correct reimbursement, and compliance. Revenue Code 0117 is widely used in cancer care billing, yet it is also one of the most commonly misunderstood room codes. Incorrect use leads to denials, underpayments, and inconsistent documentation.
This guide explains when to assign Revenue Code 0117, what it covers, the documentation requirements, and the most common errors oncology departments make.
What Is Revenue Code 0117?
Revenue Code 0117 falls under the room-and-board category 011X from the UB-04 billing form.
The 011X series includes medical-surgical, OB, pediatric, psychiatric, and other inpatient room types.
Revenue Code 0117 represents Oncology Room and Board and is specifically used when a patient receives inpatient care directly related to cancer treatment or complications from cancer treatment.
The code is intended for oncology units or inpatient beds designated for cancer patients receiving chemotherapy, radiation-related care, symptom management, or oncology-specific medical treatment.
When to Use Revenue Code 0117 in Oncology
Hospitals should assign Revenue Code 0117 only when the patient is placed in an oncology unit or when their treatment primarily involves active cancer management. Correct usage depends on where the patient is housed and the reason for their inpatient stay.
1. Patients Receiving Active Chemotherapy Treatment
Use Revenue Code 0117 when the patient is admitted for chemotherapy that requires inpatient monitoring due to toxicity risk, complications, or the need for continuous infusion.
Examples include:
- High-dose chemotherapy
- Multi-day infusion regimens
- Chemotherapy requiring inpatient hydration or monitoring
- Adverse reactions requiring immediate medical supervision
2. Patients Admitted for Radiation Therapy Side Effects
If the patient is hospitalized because of complications from radiation therapy, they qualify for Revenue Code 0117.
Typical reasons include:
- Severe radiation burns
- Dehydration related to treatment
- Intractable nausea or vomiting
- Organ inflammation resulting from radiation
3. Admissions for Oncology-Related Complications
Many oncology patients experience acute side effects from treatment that require hospitalization.
Use Revenue Code 0117 when the condition is directly tied to cancer or its treatment, such as:
- Febrile neutropenia
- Tumor lysis syndrome
- Severe anemia
- Uncontrolled pain
- Sepsis related to immunosuppression
4. Palliative or Supportive Care Linked to Cancer
If the patient is admitted for palliative care related to cancer symptoms, Revenue Code 0117 is appropriate.
Examples:
- End-stage cancer symptom management
- Complex pain management
- Nutritional support for advanced cancer
What Revenue Code 0117 Covers
Revenue Code 0117 is used to capture the inpatient room-and-board charges associated with oncology-specific care. It includes:
- Nursing care related to oncology
- Use of specialized oncology beds
- Supportive services required for cancer patients
- Medication monitoring and toxicity assessment
- Oncology-specific clinical protocols
- In-room monitoring of infusion therapy
- Infection control for immunocompromised patients
It represents the room charges only, not the chemotherapy drugs, infusion services, or procedures. Those require HCPCS, CPT, and other revenue codes.
Documentation Needed for Revenue Code 0117
Using Revenue Code 0117 without strong documentation increases denial risk. The record must clearly support that the admission was oncology-related and medically necessary.
Required documentation includes:
- Physician order for oncology admission
- Reason for hospitalization connected to cancer or treatment
- Chemotherapy plans, radiation history, or oncology treatment notes
- Nursing documentation describing oncology-specific care
- Medication and infusion records
- Laboratory results showing treatment-related complications
The diagnosis codes must match the clinical reason for admission. If there is a mismatch between documentation and billing, payers often deny or reduce payment.
Common Reasons Revenue Code 0117 Gets Denied
Oncology units often face unnecessary denials because the billing team or clinical team is not tightly aligned. These are the most common issues.
1. Incorrect Unit Assignment
If the patient is not physically housed in an oncology-designated room, some payers will not accept Revenue Code 0117. Unit mismatch leads to denials.
2. Diagnosis Not Supporting Oncology Billing
The patient must have a primary or secondary diagnosis related to cancer or treatment complications. Without cancer-related ICD-10 codes, the claim will not justify oncology room charges.
3. Insufficient Documentation
If the chart does not explain why oncology-level care was required, payers classify it as general medical-surgical care and reduce payment.
4. Missing Treatment Notes
Chemotherapy plans, infusion orders, or oncology assessments must be visible in the chart. Missing documentation results in downcoding to semiprivate or general classification.
5. Incorrect Units or Charges
Errors in room-and-board units, midnight census rules, or length-of-stay calculations cause payers to flag claims.
How to Avoid Denials for Revenue Code 0117
Hospitals can reduce denials by tightening both clinical and billing workflows. Focus on the following areas:
1. Ensure Every Oncology Admission Has Proper Justification
The attending physician must document the exact cancer-related reason for admission.
2. Align Diagnosis Codes With Oncology Treatment
Diagnosis coding must show cancer, chemotherapy, radiation, or treatment toxicity.
3. Verify Patients Are Placed in Oncology-Designated Rooms
Charge capture must match the physical bed location.
4. Audit Oncology Claims Regularly
Review room code usage, documentation, and diagnosis alignment.
5. Standardize Oncology Admission Protocols
Create checklists for:
- Nursing documentation
- Oncology order sets
- Admission criteria
- Treatment notes
Final Thoughts
Revenue Code 0117 plays a crucial role in oncology billing. When used correctly, it ensures accurate reimbursement for the specialized inpatient care that cancer patients require. When used incorrectly, payers deny or reduce room charges, leading to revenue loss. Oncology units must maintain consistent documentation, proper room assignments, and strict alignment between diagnosis codes and the patient’s treatment plan.
