Oncology & Hematology Coding Alert

Log systems that track the time physicians spend on care plan oversight (CPO) provided to patients admitted to home health or hospices can help make the paperwork hurdle more manageable for oncologists trying to collect payment for these services, advises Sharon Grimes, CPC, insurance and billing manager for West Clinic, an oncology practice in Memphis, Tenn. These are the CPO codes for home health and hospices:

99374physician supervision of a patient under care of home health agency (patient not present)
requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes

9937530 minutes or more

99377physician supervision of a hospice patient
(patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related
laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes

9937830 minutes or more

All too often, physicians are unwilling to take time away from their patients in hospices and home health agency care to gather the documentation necessary for CPO billing, she says. Consequently, they end up providing their services free. The CPO codes are among the least used by oncology practices, adds Nancy Reynolds, business manager at Baptist Regional Cancer Institute, an oncology practice in Jacksonville, Fla.

At the heart of the problem is the time it takes to keep track of each three-minute to five-minute phone call in 30-minute increments, to locate corresponding notations in the patient record, and to gather them every 30 days to submit a bill. Setting up a log system that tracks how physicians are spending their time can help, Grimes advises.

CPT 2000 uses the clinical example of a 58-year-old woman with advanced intra-abdominal ovarian cancer (ICD-9 code 183.0). The care plan includes home oxygen, intravenous diuretics for edema and ascites, and pain control management through the use of intravenous morphine. As part of CPO, the physician contacts the nurse, family and social worker by phone to discuss care, and the social worker indicates the patient wants to withdraw from supportive measures. For the physician to be able to properly bill for this care, he or she must document the review and modification and the certifications from nurses, social workers, pharmacists and durable medical equipment (DME) suppliers.

The first step to tracking CPO services is understanding the billable components to the service, says Reynolds. CPO must be accrued in 30-minute increments. The CPT 2000 provides minimal direction in this area. Individual payers will provide better detail as to their requirements. Consequently, oncologists should contact their patient's insurance carriers for a complete list of these requirements.

Implementing A Log System

Although Reynolds' current practice has yet to implement a log system, she says that physicians at her previous practice used their hospital cards as a way of documenting CPO while out of the office and as a phone log while in the office.

The hospital card, which the physicians carried with them to keep track of the patients they needed to see at each facility, allowed them to jot down the time they spent on CPO and other services. Each physician was assigned a billing staff person who was responsible for collecting the card at the end of the day, Reynolds says.

In the office, physicians noted the length of thecall, the patient being discussed, the facility or agency is caring for the patient, and made brief notes describing the nature of the CPO. The billing staff assigned to that physician was responsible for reviewing the cards and phone log, and counting the minutes each physician spent on CPO. The physician was notified when he or she had spent 30 minutes or more doing CPO for any patient, clearing the way for a billing.

Physicians still must make the proper notations in the patient chart, Reynolds stresses. A log does, however, eliminate the time physicians have to spend pouring over the chart to recall each instance they performed CPO.

Editors note: Do you have a log system that works for your practice? You can share your success stories with colleagues reading Oncology Coding Alert by e-mailing your tips and tactics today to eric_resultan@mns.com.