Oncology & Hematology Coding Alert

Question: An independent oncology physician is seeing patients who have been admitted to the hospital for observation. He has been told that he cannot bill any of his evaluation and management (E/M) services, but he can bill prolonged services time. How can this be correct?

Tennessee Subscriber

Answer: Prolonged services codes do not seem appropriate in the scenario posed by this question. Prolonged services codes (99354-99357) are considered add-on codes and are not independently billed. They are used when a physician provides prolonged service involving direct, face-to-face patient contact that is beyond the usual service and may be used in either the inpatient or outpatient setting. These codes are billed in addition to other physician services provided, including E/M services at any level.

The oncologists services should be billed as observation services if the oncologist is the admitting/supervising physician, or as consultation services if the supervising physician is calling in the oncologist.

If the oncologist in this scenario is the admitting physician, the appropriate level of observation service should be coded and documented. One of several codes will be appropriate. Codes 99218-99220 are reported for the initiation of observation status, including supervision of the care plan for observation and periodic reassessments.

If the patient subsequently is admitted to the hospital from observation status, then inpatient hospital codes 99231-99233 should be used.

Codes 99234 through 99236 are used to report observation or inpatient hospital care services provided to patients admitted and discharged on the same date
of service.

Note that when observation status is initiated in the course of an encounter in another site of service (physicians office, hospital emergency department, etc.), all E/M services provided by the supervising physician in conjunction with initiating observation status are considered part of the initial observation care. E/M services on the same date provided in sites that are related to initiating observation status should not be reported separately (i.e., office visit services should not be reported separately).

If the oncologist is not the admitting physician, but is called in as a consultant, both the admitting physician and the oncologist should have complete documentation, and the oncology services should be billed with office or other outpatient consultation codes (99241-99245).