Oncology & Hematology Coding Alert

Question: Can our oncologist file a claim for pronouncing a patient dead? This sometimes requires a lot of work, but we're not sure of how to be reimbursed.


Washington Subscriber

Answer: You may be able to charge for a death pronouncement, depending on your carrier.

At least one Part B carrier in Washington, Regence Medicare, said a year ago that it was "inappropriate" for physicians to use a discharge code to bill for filling out a death certificate. But carriers in other areas disagree.

For instance, physicians can bill for "reasonable and necessary medical services rendered up to and including pronouncement of death," according to information on CIGNA Medicare's Web site. Physicians can bill hospital discharge codes 99238-99239 (Hospital discharge day management ...) and other codes, as appropriate.

CPT guidelines (although not universally followed) state clearly that pronouncing a patient dead can count as a discharge summary. The March 1998 CPT Assistant states that the attending physician can use discharge for a death pronouncement.

Exception: If the oncologist is not the attending/admitting physician, the oncologist cannot use discharge for the death pronouncement. For instance, you could report a discharge code for more than 30 minutes (99239) or for 30 minutes or less (99238), depending on how long the service takes. As an attending diagnosis, you could cite V68.0 (Issue of medical certificates).

Also, you can bill separately for any other services the physician provides prior to the patient's death, such as CPR or cardiac conversion.

Often, hospitals will ask the physician to refrain from billing for these services. Charging a grieving family for a death pronouncement can have a disastrous effect on patient relations.

Clinical and coding expertise for this issue of Oncology Coding Alert was provided by Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.