Oncology & Hematology Coding Alert

Cancer patients now have considerable leeway in shaping their end-of-life care, while their non-hospice attending physicians can recover for their efforts. On April 1, 2002, CMS revised the Medicare Part B billing manual sections relating to attending physician claims for hospice beneficiaries (see section 4175.1).The new rules state that "[w]hen a Medicare beneficiary elects hospice care, he/she may designate an attending physician, not employed by the hospice, in addition to receiving care from hospice-employed physicians." These attending physician services are billable, if they are not already furnished under a payment arrangement with the hospice.

Before this new development, the vast majority of oncologists would continue treating their patients in hospice, regardless of the patient's ability to pay for the physician's services, says Jim Hugh, director of Atlanta-based AMAC, a coding and billing consulting firm. Now, many of the professional services that oncologists were providing for free are eligible for reimbursement.

Supervisory activities such as establishing, reviewing and updating care plans as well as supervising care and services are considered part of the hospice Medicare benefit and should be provided by the hospice medical director.

The professional services provided by the non-hospice-affiliated attending physician are not considered "hospice services." Hugh believes that "since the physicians will not be able to bill for any technical services provided by the hospice," most of the services that the attending oncologist can bill will be (E/M) visit codes (99211-99215).

"If the oncologist needs to be paid for these hospice services provided," Hugh says, "the billing department or the person responsible for authorizations and precerts will need to work directly with their counterpart in the hospice to push that through." It's best to start working together the moment the patient gets sent over to hospice, he adds.

The attestation statement from Box 19 of the HCFA 1500 claim form has been replaced. In place of the attestation statement, use the followingthree new modifiers:

-GV: Use when billing for professional services for the treatment and management of a hospice patient's terminal condition. The attending physician should use the appropriate CPT code (99377 or 99378, Physician supervision of a hospice patient) with the addition of the -GV modifier (Attending physician not employed or paid under arrangement by the patient's hospice provider).

-Q5 and -Q6: If another physician covers for the designated attending physician, the services of the substituting physician should be billed by the physician, designated as the attending by the patient, using modifier -GV in conjunction with modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) or -Q6 (Service furnished by a locum tenens physician). The physician is not an employee of the hospice and furnishes services related directly to the patient's terminal illness.

-GW: For services provided to hospice patients that are not related to the patient's terminal condition, attending physicians who are not hospice employees should use the appropriate CPT code along with modifier -GW (Service not related to the hospice patient's terminal condition).

For more information on billing Medicare Part B for hospice patients, ask your state's Part B intermediary.