Oncology & Hematology Coding Alert

Question: When is it appropriate for a physician to bill for inpatient chemotherapy, 96408-96412?
South Carolina Subscriber
Answer: There are no circumstances in an inpatient environment that would allow the physician to bill chemotherapy, 96408-96412. According to Medicare, these codes are for administering chemotherapy drugs in an outpatient setting only and physicians cannot use them because they imply that hospital staff administer the agents, the service takes place in a hospital room, and the facility provides the equipment and supplies. All of these represent an expense to the hospital and not the physician's office.
  While there is a distinction between hospital inpatient and hospital outpatient treatment, physicians generally cannot bill for chemotherapy administration in either setting. Although the patient was not admitted or assigned a hospital bed, outpatient chemotherapy treatment takes place inside the hospital. When hospital outpatient chemotherapy is provided, hospital staff also [...]