Oncology & Hematology Coding Alert

Question: How should we report our oncologist's hospice services to Medicare?

South Dakota Subscriber

Answer: Typically, you code the oncologist's hospice services using care plan oversight codes 99374-99380. Remember to report 99374-99380 separately from codes for office/outpatient, hospital, home, nursing facility or domiciliary services, according to CPT guidelines.

You will select the appropriate care plan oversight code based on the time spent with the patient and complexity of treatment that the oncologist provides in a 30-day period. Remember that only one physician may report services in that 30-day time frame. Often, the hospice physician will report 99374-99380, so make sure your physician provides the care plan services before submitting the codes. If the hospice provider supervises the patient, your physician can report only hospital or outpatient face-to-face services.

Example: Your oncologist bills for supervising a patient with breast cancer (174.x) in a home health agency for 20 minutes. Therefore, you report 99374 (Physician supervision of a patient under care of home health agency [patient not present] in home, domiciliary  or equivalent environment [e.g., Alzheimer's facility] ... within a calendar month; 15-29 minutes). If the physician also wanted to bill for an evaluation with the patient in the office, you could separately report the appropriate established patient code (99212-99215), depending on documentation.