Oncology & Hematology Coding Alert

When New York City Mayor Rudolph Giuliani announced that he had prostate cancer at the end of April, he sent a clear message to men across America to be screened for the disease. At the end of May, however, he was still mulling over his treatment options (see box below). In the interim, he had withdrawn from the Senate race and announced that he and his wife would be separating. An obviously turbulent month for the former prosecutor known as a man with a very stiff upper lip, the month was also, according to news reports, filled with discussions with his doctors about how to treat his cancer. An oncologist may be involved as a consultant, or he/she may assume primary care of the case. How does the oncologist code for all of the time involved in discussing the treatment options with a prostate cancer patient? And what are the codes for possible treatments?

The first opportunity for reimbursement comes if the treating physician requests the oncologist to consult regarding the patient. In that case, the oncologist can bill 99241-99245, says Elaine Towle, CMPE, practice administrator with New Hampshire Oncology-Hematology in Hooksett. The level of consultation depends on three key components: patient history, examination, and the complexity of medical decision-making. Towle recommends that consulting oncologists document the detail of the patient history, including past history, social history and family history; the number of body systems examined and the complexity of establishing a diagnosis or treatment option. As with any consultation, the three Rs should be documented in the patients record: request (for a consultation), review (of the case) and report (in writing).

As with all types of cancer diagnoses, a considerable amount of time may be required to provide counseling and support to the patient following the cancer diagnosis. If over 50 percent of the time spent with the patient is for counseling, time becomes the key component for selecting the level of E/M service, explains Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding, reimbursement and compliance consulting firm based in Denver. For example, if the oncologist spends 10 minutes taking the history, doing the physical examination and performing medical decision-making, and then spends an additional 30 minutes on counseling the patient about treatment options, the risk of complications, and the prognosis, then the total time spent with the patient is 40 minutes. This means that the oncologist could bill 99215 (established patient), 99204 (new patient) or 99243 (consultation) for such a visit, says Page, depending on how the patient presented. If it were Giulianis first visit, it would be 99204 or 99243; if a subsequent visit, it would be 99215.

Documentation is very important, as always. The documentation must include the time spent performing services and counseling the patient, says Page. There should also be a brief overview of what was discussed. Any psychological counseling done by the oncologist should be reported with an E/M services code; the level is determined by the total time spent.

Prostate Cancer Treatment Codes There are a variety of treatment options for prostate cancer, which may be one reason it takes time for the oncologist and patient to decide on one. Here are the codes: 55801-55845: prostatectomy 55859-55865: seed implantation G0160 (Medicare only): cryosurgical ablation of localized prostate cancer, primary treatment only (postoperative irrigations and aspiration of sloughing tissue included) G0161 (Medicare only): ultrasonic guidance for interstitial placement of cryosurgical probes 54530-54535: orchiectomy J9217: Lupron J9202: Zoladex 96400: chemotherapy administration (can be billed with E/M visit)