Oncology & Hematology Coding Alert

Question: We are having problems collecting payment for care plan oversight (CPO) services provided to patients admitted to home health and hospices. We don't have enough documentation showing the time physicians spent providing these services. How can we improve payment? New Jersey Subscriber Answer: Log systems that track the time physicians spend with patients will help you nail payment for these services described by the following CPO codes for home health and hospices:
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) for purposes of assessment or care decisions integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes
99375 ... 30 minutes or more
99377 Physician supervision of a hospice patient (patient not present) for purposes of assessment or care decisions integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes
99378 ... 30 minutes or more. CPT 2003 uses the clinical example of a 58-year-old woman with advanced intra-abdominal ovarian cancer (183.0). The care plan includes home oxygen, intravenous diuretics for edema and ascites, and pain control management using intravenous morphine. As part of the CPO, the physician contacts the nurse, family and social worker by phone to discuss care, and the social worker indicates that the patient wants to withdraw from supportive measures. For the physician to bill properly for this care, he must document the review and modification and the certifications from nurses, social workers, pharmacists, and durable medical equipment (DME) suppliers.

Tracking down the amount of time the physician spends on this and other CPO services is a tedious task for many oncologists and oncology coders. You have to keep track of each three-minute to five-minute phone call in 30-minute increments, locate corresponding notations in the patient record, and gather them every 30 days to submit a bill. Set up a log system to track how physicians are spending their time. You could have your physicians use hospital cards as a way to document CPO while out of the office or as a phone log in the office. The physicians jot down the time they spent on CPO and other services on the hospital card the physicians carry to keep track of the patients seen at each facility. In the office, the physician notes on the card the length of a phone call, the patient being discussed, and the facility or agency caring for the patient, and makes brief notes describing the nature of the CPO.

At the end of the day, the physician gives the hospital card [...]