Five Tips for Maximizing Payup During Initial Cancer Diagnosis Appointment
Published on Sat Jan 01, 2000
Newly diagnosed patients require considerable resources from oncology practices in the form of counseling and education about their condition, treatment options and prognosis. Family members, too, want to know what the future holds for their loved ones. It may not be possible to recoup all the time spent with patients during this period, but detailed documentation and skilled use of the evaluation and management (E/M), prolonged services codes and team conference codes can help.
Tip 1: Documenting
Consultations Appropriately
When an encounter with the patient is provided as a consultative service, its important that both the requestor and consultant follow the request-render-report standard stressed by Medicare and in CPT 2000. The patient should be referred by the other physician in writing, and the oncologists visit should be acknowledged to the other physician in writing, stating that he initially saw the patient in consult only, advises Susan Arfken, practice manager for Somerset Hematology and Oncology Associates in Somerset, N.J.
Use Medicare Transmittal No. 1644 issued in August as your guide:
1. A consultation is distinguished from a visit
because it is provided by a physician whose
opinion or advice regarding evaluation and/or
management of a specific problem is requested by
another physician or other appropriate source
(unless it is a patient-generated confirmatory
consultation).
2. A request for a consultation from an appropriate
source and the need for consultation must be
documented in the patients medical record.
3. After the consultation is provided, the consultant prepares a written report of his/her findings, which is provided to the referring physician.
Similarly, according to CPT 2000, The written or verbal request for a consult may be made by a physician or other appropriate source and documented in the patients medical record. The consultants opinion and any services that were ordered or performed must also be documented in the patients medical record and communicated by written report to the requesting physician or other appropriate source.
Tip 2: Counseling Time to Determine E/M
Time spent counseling patients about their prognosis and treatment options can consume an oncology visit. With appropriate documentation, that counseling time can override the other criteria used to determine the E/M level.
Some oncologists overlook this, but you can bill for counseling when it takes up more than 50 percent of the total time of the visit, instead of going by the level of history, exam and medical decision making involved, explains Laurie W. Lamar, RRA, CCS, CTR, CCS-P, reimbursement specialist at the American Society of Clinical Oncology.
For example, after an initial visit and diagnostic tests, you may meet with a patient for 25 minutes. If you spend only ten [...]
