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Oncology & Hematology Coding Alert

Real-Life Solutions:

What You Need to Know to Report Chemo Planning

Published on Wed Sep 01, 2004

Hint: E/M codes help get you the pay you deserve

Do you want to report the oncologist's chemotherapy teaching and planning services? If so, you should avoid coding myths, which could lead to audits and denials, and stick with payer guidelines and the appropriate E/M codes. Use these tips to ethically code teaching and planning for chemotherapy.

Count Planning as Part of the E/M

When the oncologist plans a chemotherapy treatment, such as writing prescriptions or scheduling a course of treatment, you should include this service with the E/M code, says Cindy Parman, CPC, president-elect, AAPC, in Dallas, Ga. "I am not aware of any insurance payer, commercial or governmental, that provides separate reimbursement for a chemo planning fee," Parman says.

Even so, oncology coders often debate whether you can report the physician's chemotherapy planning as
96410-26 (Chemotherapy administration, intravenous; infusion technique, up to one hour; professional component) when billing commercial carriers for hospital services.

Best bet: Unless your contract with your private carrier specifically states you can report 96410-26 for chemotherapy planning, you should report the appropriate E/M service (99201-99205, 99211-99215).

Lesson Learned: Use 99211 for Teaching Services

Suppose a patient presents for an office visit, and the nurse provides chemotherapy teaching in addition to completing history, exam and medical decision-making. You can report 99211 (Office or other outpatient visit ...), as long as the documentation supports the charge. 

The documentation should show that the nurse educated the patient on the treatment's side effects, drug tolerance, diet and nutrition, Parman says.

The attending physician would have to order the visit. Also, some insurers don't consider "patient education" to meet the definition of 99211, which states the service is "minimal" and requires about five minutes of service, Parman says.

Important: No specific CPT code exists for this service, because a nurse or other ancillary personnel performs the teaching in the physician's office, Parman says.

But the CPT manual does list some interesting codes related to these services:

  •  99071 - Educational supplies, such as books, tapes, and pamphlets, provided by the physician for
    the patient's education at cost to physician.

    Most payers do not reimburse for this code without a great deal of hassle for physicians, says Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C. Insurers usually consider supplies as part of other charges, such as for E/M services.

  •  99078 - Physician educational services rendered to patients in a group setting (e.g., prenatal, obesity, or diabetic instructions).

    Although 99078 describes educational services, the code also requires physician presence and would not apply to services that a member of the physician's staff performs, Parman says.

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