Oncology & Hematology Coding Alert

Providers must have a valid Medicare PIN

When one of your office's nonphysician practitioners (NPPs) performs a routine checkup on a long-term cancer patient, you may be able to report the service incident-to the physician, a practice that has myriad benefits for your bottom line.

Oncology offices nationwide value NPPs who can perform incident-to services, because the incident-to rules allow approved NPPs to provide certain services without the physician present - yet still bill them under the physician's personal identification number (PIN).

Benefits: Incident-to providers free up physicians to provide higher-level services to your patients. Also, when an NPP uses the oncologist's PIN to file the claim, Medicare will reimburse fully for the code; if the NPP uses her own PIN, Medicare pays only 85 percent of the code value, says Kimberly Green, CPC, project coordinator at the University of Pittsburgh Physicians.

Follow us for some expert advice on accident-free incident-to coding. Medicare Will Make Most Incident-To Payments

Before you  report incident-to services, know that incident-to is a Medicare phenomenon, and private companies may not consider this convention kosher. Most non-Medicare payers do not recognize staff - regardless of credentials - as providers of physician services, experts say.

Best bet: Before reporting NPP services to private carriers, contact the carrier to see how they would like the claim filed.

Many Ancillary Staff Can Provide Services Most ancillary staff with the right training may provide incident-to services on behalf of an in-office, supervising physician. This could be a medical assistant (MA), registered nurse (RN), physician assistant (PA), certified nurse specialist (CNS), or nurse practitioner (NP) - among others. No matter who it is, "proper training" for all incident-to service providers stipulates that incident-to providers be enrolled in Medicare with a valid PIN and have a state license.

The work that incident-to service providers perform depends on their area of expertise and the state's scope-of-practice guidelines.

Who does what? MAs and RNs will most likely provide educational services and give injections and infusions; CNSs, NPs and PAs typically perform minor procedures and E/M work.

Example: Let's say your office's RN is seeing an established chemotherapy patient with colon cancer for a checkup. Over the course of a four-minute encounter, the RN:

conducts a medical examination of the patient, reviews recent laboratory test results

adjusts the patient's pain medication dose, and asks the patient about side effects of pain medication. On the claim, you should report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services) incident-to the physician service.

As long as the patient is not new or undergoing [...]