Medicare Compliance & Reimbursement

Question: From his office, an oncologist reviews lab test results and, by telephone, orders additional testing and medication changes for nursing facility patients. Can the physician charge for this work if he does not see the patient face-to-face? Can a nurse performing the same services from the office charge for these services as “incident to”?

Answer: No. Without a face-to-face visit the physician cannot charge for his telephone evaluation and orders. A nurse also cannot bill an “incident-to” service outside of the office. In this case, no direct face-to-face service occurred between the patient and the physician/nurse, even though the doctor discussed over the phone with the patient’s caregiver the results of tests and ordered further studies.

Good news: Your oncologist may not be giving away his reviews/medical orders for free. E/M services include some related pre- and post-work time, so reviewing lab results might be included in a future related face-to-face nursing facility visit (such as 99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient ...).