Oncology & Hematology Coding Alert

Question: If my oncologist talks to a patient on the phone and communicates medical decision-making information, can I report an E/M code?


Wyoming Subscriber
Answer: Not quite. But your payer may allow you to count this discussion toward coding the next E/M with this patient if the physician reviews the MDM with the patient.

Rule: -A physician cannot bill for phone calls, but the services he provided could be incorporated into the level of complexity of the next E/M service,- says Part B carrier Noridian Administrative Services in a -Frequently Asked Questions- file on its Web site.

But you can't use phone time to increase the amount of time for counseling and coordination of care, which is based on face-to-face time, Noridian says.

Beware: Don't let your oncologist get the idea that every phone call should boost E/M reimbursement.

The relative value units (RVUs) for E/M codes include work before and after the visit, including -reviewing records and tests, arranging for further services, and communicating further with other professionals and the patient through written reports and telephone contact,- according to the CPT manual. So phone calls should usually be bundled into the E/M visit without affecting the level of service.

Look for specific signs that a phone call was significant and should count toward the next E/M visit. These include:

- the decision for more treatment after the phone call
- a prescription (or even a refill) or a dosage change over the phone
- discussion of new symptoms
- the decision that a condition is worsening, or a new condition has been added
- informative chats with family members and previous providers. Any of those factors would increase the complexity of medical decision-making at the next visit.

The oncologist should document exactly what she discussed with the patient, to justify the increased E/M level in case of an audit.