Oncology & Hematology Coding Alert

Question: A lung cancer patient came to the practice in the morning, and Oncologist A found tachycardia and ordered an echo the same day. The patient returned later that afternoon, and Oncologist B saw the patient for counseling and coordination of care for the same problem. Both physicians share the same specialty, so can I combine their notes to report a higher-level E/M?

Idaho Subscriber

Answer: Medicare 30.6.5 Physicians in Group Practice (Rev. 1, 10-01-03) states that physicians in the same group practice who share the same specialty have to bill and be paid as though they were a single physician.

If a patient receives more than one same-day E/M (face-to-face) service by the same physician -- or more than one physician in the same specialty in the same group -- you can report only one E/M service. The only exception would be if the E/M services are for unrelated problems. Instead of billing separately, the physicians should select a service level that represents the combined visits and submit the appropriate code for that level.

Physicians in the same group practice who are in different specialties can bill and be paid even if they-re members in the same group.

Tip: Be prepared to send documentation if the payers deny the claim and you need to appeal.