Oncology & Hematology Coding Alert
Be Careful When Billing After-Hours Care
Question: Our normal office hours are 8:30 a.m. to 5:30 p.m. Monday through Friday. Occasionally, we see patients during non-office hours, but we're stuck on how to bill these visits. In what situations should we consider reporting after-hours codes? Answer: You should never report after-hours codes to Medicare, because it never pays for them. With private payers, however, consider after-hours codes only if the patient presents after your normal office hours end - not when a patient presents during normal office hours and the appointment runs past "closing time." Scenario 2: The office closes at 5:30 p.m., and the oncologist takes until 6:00 performing a level-four E/M service on a new patient. You should:
Wisconsin Subscriber
Scenario 1: The office closes at 5:30 p.m., and an established patient reports at 5:45 p.m. for a level-four E/M visit. You should:
medical decision-making of moderate complexity).
Remember: There are three different after-hours codes, each designed for use in specific situations. If the doctor sees a patient at 2 a.m. on a Wednesday, you should include the after-hours code 99052 (Services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service) in addition to the service code.
If the physician provides services on a Sunday or holiday, opt for 99054 (Services requested on Sundays and holidays in addition to basic service) in addition to the service code.
Make sure to contact the insurance company before filing after-hours codes: Some private payers have followed Medicare's lead and won't accept the codes.
Oncology & Hematology Coding Alert
- Injection Code Smarts Sharpen Chemo Claims
Nonchemo injections have their own code set When checking a procedure report, you should know [...] - No Chemo Drugs? No Chemo Injection Code
1 injection code is the norm on therapeutic shots So you've decided that the service [...] - News You Can Use:
New Imaging Codes Coming in CPT 2005
PET scan family getting an update
Sources indicate that CPT will add several codes to its [...] - Stop Modifier -25 Headaches Before They Start
Documentation must prove a separate E/M service
If your oncologist takes a bone marrow biopsy and [...] - You Be the Coder:
When Basic Dosimetry Gets Special
Question: We think our oncologist may have performed special dosimetry on a patient recently, which [...] - Clarification:
Pegfilgrastim and Filgrastim
In the October 2004 Oncology Coding Alert, the article "News You Can Use: How to [...] - Reader Question:
Think Medicare May Not Pay? Get an ABN
Question: What exactly is an advance beneficiary notice (ABN), and how do they relate to [...] - Reader Question:
Append Modifier -32, but Don't Expect More Money
Question: Our oncologist spends a lot of time on confirmatory consultations that insurers request, which [...] - Reader Question:
Be Careful When Billing After-Hours Care
Question: Our normal office hours are 8:30 a.m. to 5:30 p.m. Monday through Friday. Occasionally, [...] - Reader Question:
If Diagnosis Is Already Known, Don't Report E/M Service
Question: We have a patient with chronic myeloid leukemia who undergoes regular chemotherapy injection treatments [...]
