Oncology & Hematology Coding Alert

Question: I work at a cancer center at a teaching hospital. Lately, we have been getting a lot of denials for patients who see multiple doctors from different disciplines because our surgeons and medical oncologist work together on some days. What is the appropriate modifier to relay this information on a claim?

Arkansas Subscriber

Answer: When a hospital clinic is billing for services separate from the professional fee, billing takes a different twist. The physician practice should be billing for the professional component only and should be applying modifier -26 (Professional component) to the procedure code. The physician practice rightly bills the professional fee while the hospital bills the technical portion. The hospital, as you describe, may house a number of physician practices surgeons, medical oncologists, etc. Appropriately, the hospital should be reimbursed for the services provided when these services are independent of each other.

The modifier specifically intended for your situation is modifier -27 (Multiple outpatient hospital E/M encounters on the same date). This modifier should be added to each appropriate level of outpatient E/M. This modifier should not be used for reporting of multiple E/M services performed by the same physician on the same date.

Answers to the Reader Questions and You Be the Coder were provided by Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; and Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm.