Oncology & Hematology Coding Alert

Question: All dosimetry/physics are performed by a dosimetrist/physicist employed by our group. The group bills for the technical component, specifically the physics services that they perform. Should the hospital bill Medicare and reimburse us, or should we bill Medicare directly?

Arizona Subscriber

Answer: If a patient in a hospital inpatient facility is transported to a freestanding center for therapy, the technical component of the radiation oncology services (including physics) cannot be paid to the freestanding center, according to the Medicare Carriers Manual Section 15022.B 1, 2. The patient must be discharged and readmitted to the hospital, or the freestanding center may receive payment from the hospital through a contractual arrangement.

Although the subscriber's situation is not exactly the same, it is similar. The physicians should enter into a contractual arrangement with the hospital for the physicist services, such as 3-D simulations (77295). There are potential dangers relating to regulations and laws, and you should have legal counsel review the contract, determining "fair market value," for example.

There have been problems with some payers that say a place of service reflects the patient's location and not the equipment or the provider's location. Therefore, if the patient did not come to the office for the 3-D planning process, the place of service would remain in the hospital, whether inpatient or outpatient.

Answers to the Reader Questions and You Be the Coder were provided by Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; Cindy Parman, CPC, CPC-H, president of co-founder of Coding Strategies in Dallas, Ga; and Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett.