Primary Care Coding Alert

Question: What code do I use when the patient is under hospice care (at home) and the physician is not employed by the hospice?

Paul G. Thomas, MD, Mich.

Answer: If the patient is on Medicare, services related to the terminal illness may be billed by the family physician (FP) to Medicare Part B, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. Patients must have designated the physician as their attending doctor, and that FP must not be an employee of the hospice.

The FP may bill for any appropriate evaluation and management (E/M) services99347-99350 (home visit for the evaluation and management of an established patient, which requires at least two of these three key components: ranging from a problem focused to a comprehensive interval history, a problem focused to a comprehensive examination and straightforward decision-making to one of moderate to high complexity)as well as for services not related to the terminal illness. Stradley notes that even though a beneficiary elects hospice coverage, he or she may designate an attending physician who is not employed by the hospice to furnish professional services in addition to those provided by hospice-employed physicians.

Health Care Financing Administration (HCFA) policy states: Only an attending physician who has been selected by the beneficiary and is not employed by the hospice may bill Part B for services related to the treatment and management of the terminal illness. Other physicians may bill Part B for services rendered which are not related to the terminal illness.

If youre not sure whats considered related to hospice care, check with the hospice, advises Carol Gibbons, CPC, a coder with the University of Missouri-Columbia Medical Practice, which has 25 physicians. She also notes that FPs shouldnt see hospice patients for hospice-related problems because the hospice physician manages the terminal illness.

The professional services of an attending physician that are reasonable and necessary for the treatment and management of a hospice patients terminal illness are not considered hospice services, and may be billed to Part B, provided they are not furnished by the FP under a payment arrangement with the hospice, Stradley says. Private physicians attending hospice patients should enter documentation in Item 19 of the HCFA-1500 and say: Dr. (name of doctor) is the patients designated attending physician and is not employed nor paid by the hospice for these services.

Gibbons says that FPs treating non-Medicare patients in a hospice setting should bill for the home visits as they would for any other patient, along with any other services performed.