Oncology & Hematology Coding Alert

Neoplasm and fatigue could mean higher MDM There's no time like the present to hone your E/M coding skills. Read on to sharpen your coding senses to a fine point using the answers to three important E/M questions submitted by our readers What Happens When Attending Isn't Available? Question: Dr. Jones admits a patient to the hospital, and three days later the patient is ready to be discharged, but Dr. Jones isn't available. My understanding is that Medicare allows only the admitting physician to bill a discharge for the patient. So in this situation, how can we get paid for the discharge (99238-99239) since a different member of our practice performed it? Answer: Go ahead and bill that discharge. Because the physicians are all members of the same group, any of them can perform the discharge, says Suzan Berman-Hvizdash, CPC, CPC-EMS, CPC-EDS, physician educator with UPMC in Pittsburgh. Take note: This recommendation appears in the Medicare Claims Processing Manual, advising that "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician." You can find more information on the CMS Web site at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. How Best to Report Hospice-Performed Consults? Question: If an oncologist visits a patient in the hospice and performs a consult, does the physician report a normal consult code (such as 99241) or does he report G0337? Answer: In this situation, G0337 (Hospice evaluation and counseling services, pre-election) is probably not the correct code "because this evaluation is to determine if the patient would like to be placed in hospice," says Kevin Solinsky, CPC, CPC-I, CPC-ED, with Healthcare Coding Consultants LLC in Gilbert, Ariz. Code G0337 specifically says, "hospice evaluation and counseling services, pre-election," which means you should bill it before the patient decides to enter into a hospice program, Solinsky says. In addition, always remember the "three R-s" of billing consults, even in the hospice setting. You need to document "the consult request, rendering of the consult, and replying back to the requesting provider in writing," Solinsky says. If the visit didn't meet CPT's or the payer's definition of consult, this was most likely a new or established patient visit. If this is the case, you should bill it with the appropriate office/outpatient code, such as 99201-99215, Office or other outpatient visit. Always Establish Adequate E/M Requirements Question: When I-m coding a high-level E/M for an established patient, I can usually meet the requirement for either history or examination. What else do I need to do to submit the E/M correctly? Answer: For established patient E/M codes 99214-99215, you need to meet the appropriate level for at least two of three requirements: [...]