Oncology & Hematology Coding Alert

Question: After completing subsequent nursing facility care for a patient recently, I met with her team of physicians to review the case. Can I bill 99361 in addition to 99307-99310?

Colorado Subscriber

Answer: Probably not, particularly if you-re billing the service to Medicare. The nursing facility care codes- descriptor states, -... counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem and the patient's and/or family's needs.-
 
Therefore, your E/M service includes meeting with other physicians and health professionals.
 
A typical subsequent nursing facility visit might include the physician's time with the patient, a review of her chart, a discussion with the charge nurse regarding the patient's behavior and/or interval history, and meeting with the rest of the patient's team of providers to discuss treatment plans and other issues.
 
You would include these items as part of the evaluation and management code. Choose the appropriate code -- 99307-99310 (Subsequent nursing facility care, per day, for the evaluation and management of a patient ...) -- based on the history, examination and medical decision-making that you document.
 
Heads up: Medicare's RBRVS file classifies 99361 (Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care [patient not present]; approximately 30 minutes) as a bundled status. Translation: Medicare won't process the code for separate reimbursement. Medicare generally doesn't reimburse for services when the patient is not present; it pays for -direct patient services,- which require the patient's presence.
 
But some private payers may reimburse team conferences involving different specialists. To make the most of your oncologist's coordination of care, contact your individual insurer for its guidelines before reporting these codes.
 
Tip: Make sure your documentation includes the meeting participants, the treatment plan, and proof of the time spent discussing the patient.