Oncology & Hematology Coding Alert

Question: At the practice I represent, we have a nurse practitioner who routinely has one-on-one educational sessions about self-management for patients getting ready for chemotherapy. I’m not sure how to properly code for this ARNP’s time. Any suggestions?

Delaware Subscriber

Answer: For one-on-one education on post-chemo self-management, use the code 98960 (Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; individual patient).

Be careful. There is a time limit on this code. These sessions are only 30 minutes — meaning that beyond 30 minutes, an educator cannot be compensated.

Another helpful thing to keep in mind is that this code can be modified to include more patients. Use the code 98961 (… 2-4 patients) and 98962 (… 5-8 patients) if your qualified, non-physician health care professional is working with multiple patients.

Here’s one more useful code for you today! Remember the code 99078 (Physician or other qualified health care professional qualified by education, training, licensure/ regulation [when applicable] educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions]). In situations where you are educating more than eight patients, consider using this more comprehensive code that includes larger groups. Here are some 99078 tips:

• This code is not time based, meaning you can report 99078 for each patient involved.
• You will need to include a diagnosis code related to the reason for the education.
• Include an E/M code for the office visit and append modifier 25.
• If, however, your provider provides individual education, you should report the appropriate E/M code for that office visit instead of 99078.
• Some payers may not reimburse 99078, but you can still report this code for tracking purposes.