Oncology & Hematology Coding Alert

Question: We are a private group of radiation oncologists starting up a prostate implant program and will be working with area urologists to provide this service to surrounding hospitals. We own all of the implant equipment (ultrasound, mick gun, etc.) and supply our own physicist. Do we bill the technical component to the insurance company or does the hospital bill them and we invoice the hospital?

New Jersey Subscriber

Answer: When services are performed in the hospital, the facility should code and bill for them as the radiation oncologist does. For example, 77290 (therapeutic radiology simulation-aided field setting; complex) has both technical and professional components because it requires the expertise of the physician and the equipment owned by the facility.

HCFA has stated that physicist charges such as 77370 (special medical radiation physics consultation) are a facility expense and must be charged by them, regardless of who employs the physicist. The same would be true for the technical component of equipment. Despite the practice owning the equipment normally owned by the hospital, it cannot bill Medicare because Medicare considers the technical portion a facility-only charge. They offer the following guidelines for a provider to bill for the technical component:

Own or lease the space at fair-market value;
Own or lease the equipment at fair-market value;
Employ the technical staff in an arrangement that meets the employer/employee relationship as defined by the Internal Revenue Service.

The decision to bill for this should be made with the assistance of a lawyer specializing in healthcare. It may require the radiation oncology practice to enter into a legal arrangement with a hospital in which the two share in revenue collected by the hospital using practice-owned equipment. Certain arrangements such as joint ventures may assist with billing and collecting capital investment.

Answered by Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a coding consulting firm in Dallas, Ga.