Oncology & Hematology Coding Alert

Question: Is the amount of time involved in teaching patients about chemotherapy part of the facility fee, or is it assumed to be bundled into the chemo procedure code? The teaching is performed by the chemo nurses during the administration time that they are in the treatment room.

Louisiana Subscriber

Answer: You should do teaching during assessment before chemotherapy starts. If you are hospital-based, then this cost is covered under the point system in the facility fee. If you work in a private office, it is covered in the time element of the office visit and therefore covered by the E/M code.

Some coders believe that chemotherapy teaching, if performed as a separate visit in a private practice, can be billed as 99354-99359 (Prolonged services). However, the more common and conservative viewpoint holds that since the physician does not see the patient for chemo teaching, it is inappropriate to use the prolonged services code.