Oncology & Hematology Coding Alert

Question: Several of us have offices on the same floor as our hospitals cancer treatment center, where our patients go for their chemo treatments. We spend from 10 minutes to eight hours (with iv hydration, etc.) with our patients, examining them, writing their chemo orders after checking their blood results and then arranging for their treatment. Our doctors are available and responsible for their care while they receive their treatments.

The hospital supplies and charges for their chemo drugs and pays the salaries of the nurses in the center.

We have been told that all we can bill Medicare for is an office visit. This seems totally unfair and inappropriate; is it correct?

Louisiana Subscriber

Answer: If I understand your situation correctly, you work with a physician group that uses a hospital-based infusion center. Your concern is that the patient is at the infusion center for an extended period of time, yet your practice cannot bill for the procedures. The hospital-employed staff are providing the procedures, such as the infusion of the chemotherapy and any other related activities. The staff or their employers are the only ones who can bill for the procedures, in this case the hospital.

The physician can bill for an evaluation and management (E/M) code because he/she evaluates the patient and the lab results and writes the orders. This E/M code, of course, can vary and should correspond with the level of decision-making and evaluation performed and documented. Documentation is key when billing an E/M code concurrent with chemotherapy administration.

If the patients are receiving their chemotherapy in a different setting, such as the physician office, and that physician or group employs the staff, then the chemotherapy administration procedures could be billed based on the activity and the length of the procedure.