Oncology & Hematology Coding Alert

Question: Our oncologist is part of a large internal medicine group. In his absence, the nursing staff follows the planned treatment protocol and administers chemotherapy (90780 and 90782). One of the internal medicine physicians agrees to oversee the nurses. First, does this meet the requirement for direct supervision for Medicare? Second, do I bill the service under the supervising physician or the ordering physicians provider number?

Texas Subscriber

Answer: Medicare covers certain services furnished by nurses and other nonphysician staff under Medicares provision for services furnished incident to a physicians service. It covers all services furnished by staff in the office setting, including evaluation and management (E/M) and administration of drugs and fluids (99211-99215). The incident to requirement also applies to chemotherapy services (96400-96549) given, not just nonchemotherapy infusions (90780 IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour).

Medicare explains the requirements for coverage under the incident to provision in the Medicare Carriers Manual (MCM) Section 2050. One of the most important factors is a physicians direct personal supervision. Although the physician does not have to be in the same room, he or she must be present in the office and immediately available to provide assistance and direction. The attending physician does not have to be the patients personal physician, but can be any member of the same group practice.

The MCM (2050.1B) further states that the availability of the physician by telephone and the presence of him or her somewhere in the institution does not constitute direct personal supervision. To meet the requirement, the supervising physician must be present in the office.

When all incident to requirements are met and the supervising physician is not the patients physician, the question is which physician should be indicated on the Medicare claim as having furnished the service. Medicare carriers differ in their advice on this issue. They may want to identify the physician who was physically present. This method would preclude any charge that an improper claim was submitted. If you choose to identify the patients physician on the claim, be sure to document who was present during the service.

Answered by Laurie Lamar, RHIA, CCS, CTR, CCS-P, reimbursement specialist with the American Society of Clinical Oncology in Alexandria, Va. Her position does not reflect the opinion of ASCO.