Oncology & Hematology Coding Alert

Question: Can our oncologist bill chemotherapy administration as an incident-to service?

California Subscriber

Answer: If the oncologist pays the staff nurses who administer chemotherapy, you can bill the services as "incident-to." But if hospital nurses provide the chemotherapy services, you cannot bill the chemo as incident-to.
 
You may report E/M codes (99211-99215) along with the chemotherapy administration (96400, Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia) only when the oncologist provides assessment and patient management services that exceed the physician's normal services.
 
For example, the nurse completes an entire patient evaluation before starting the chemotherapy and notes problems related to the patient's cancer or cancer treatment, such as diarrhea (787.91).
 
If the nurse then discusses the problems with the physician, you can report 99211 (Office or other outpatient visit ... established patient). But make sure the nurse documents the evaluation and discussion with the physician.

Also, check to see if your payer requires you to use modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to demonstrate that the nurse performed an E/M unrelated to the chemotherapy administration.