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Oncology & Hematology Coding Alert

You Be the Coder:

Outpatient Chemotherapy Precludes E/M Billing

Published on Wed Jan 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: We have a patient who received chemotherapy in an outpatient clinic that is part of a hospital. The patient stayed in the outpatient clinic for at least eight hours and was then admitted as an inpatient at the end of the day. The oncologist saw the patient at the initiation of the chemotherapy and provided the oversight for the patient's care during the clinical portion of the treatment.

Once the patient was admitted, the oncologist also provided the inpatient portion of the care. Hospital-employed nursing staff handled the actual infusion procedures. The supplies and the equipment were provided by the hospital.

I would like to know how the physician's charges should be billed for the initiation of the chemotherapy, oversight of the chemotherapy administration, and the inpatient care. Would it be inappropriate for the physician to bill for the infusion procedures (96410-96412) since the hospital-employed nurses are actually providing the service? Would the code for initial hospital care cover all of the physician's services for the day?

Minnesota Subscriber

 


 

 

Answer: When a private-practice physician provides chemotherapy in an outpatient hospital setting, he can bill for his E/M visit as appropriate. However, the physician cannot bill for a 99211 (Office or other outpatient visit ... that may not require the presence of a physician) when the services are provided by the hospital-employed RNs.

In the scenario you describe, there is an added twist that makes things a little more interesting. This patient began treatment in the outpatient arena but was admitted as an inpatient that evening. When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service, such as the emergency department, physician office or outpatient clinic, all evaluation and management services provided by the physician are considered part of the initial hospital care when performed on the same date as the admission.

However, if the admission is related to the chemotherapy visit (as appears to be the case here), then the physician can only bill for initial hospital care using the appropriate level of service, 99221-99223.

 



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