Can you bill a E/M level (99212 etc.)in Radiation Oncology for the patients weekly assessment with the Oncologist along with the daily treatments? This has been an ongoing situation here at my hospital because no one can seem to find the answer.
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Wiki Radiation Oncology
- Thread starter mslori7
- Start date
JM.Geyer
Guest
you would use the weekly management code of 77427 instead of the regular E/M codes as this takes the place of the E/M codes while a pt is on treatment. Now if a pt comes in once treatment has been completed then you would charge your E/M.
Thanks for the information, the department got back to me on this as well. I'm now told that they were advised to charge E/M levels not specifically for the physicians or physics, but for nursing care of the follow up patients. This sounds very wrong for nurses to charge these types of services when they are not physicians. Also, the manager stated that the 77427 is not reimbursed by Medicare as I looked this up and found to be true. What is your take on this and do you have any websites that I can visit to pull documentation for this huge problem? I know that the RAC is coming soon and I'm trying to get the department to stop sing such methods before they are really penalized by Medicare for this as Medicare have been paying for the E/M levels.
Thanks,
Thanks,
hodgeskm
Contributor
Clinic Visits
I've found information on "Clinic Visits" simply by Googling, on the AAPC site, the AHIMA site, and CMS site. Also, just so you know your information has "legit" background, clinic visits have been discussed in the Hospital Outpatient Proposed and Final Rules (Medicare) several years running, including a comment period for leveling and potential for new code assignment. Generally speaking, hospitals will coordinate between their OP clinics so that there is some level of standardization in assignment of code level. This takes some thought and coordination, as specialty areas can be so different in terms of care provided. Currently, the E&M CPT codes 99211-99215 and 99201-99205 are utilized to report clinic visits.
For example - this FAQ is from the Highmark Medicare Services Website (MAC J12):
As an Outpatient Hospital facility, how would we most accurately code our emergency department and clinic visits?
When the Outpatient Prospective Payment System (OPPS) was implemented, providers were instructed to follow their own system for assigning the different levels of HCPCS codes. Hospitals are in compliance as long as:
The services are documented and medically necessary;
The facility is following its own system; and
The facility's system reasonably relates the intensity of hospital resources to the different levels of HCPCS codes.
The cross-walk to the level of service provided should be available upon request.
Note that in my experience, some private payers do not reimburse for clinic visits, so insurance verification, establishing patient liability, and ensuring patients understand this liability are importtant to the process.
Good Luck!
I've found information on "Clinic Visits" simply by Googling, on the AAPC site, the AHIMA site, and CMS site. Also, just so you know your information has "legit" background, clinic visits have been discussed in the Hospital Outpatient Proposed and Final Rules (Medicare) several years running, including a comment period for leveling and potential for new code assignment. Generally speaking, hospitals will coordinate between their OP clinics so that there is some level of standardization in assignment of code level. This takes some thought and coordination, as specialty areas can be so different in terms of care provided. Currently, the E&M CPT codes 99211-99215 and 99201-99205 are utilized to report clinic visits.
For example - this FAQ is from the Highmark Medicare Services Website (MAC J12):
As an Outpatient Hospital facility, how would we most accurately code our emergency department and clinic visits?
When the Outpatient Prospective Payment System (OPPS) was implemented, providers were instructed to follow their own system for assigning the different levels of HCPCS codes. Hospitals are in compliance as long as:
The services are documented and medically necessary;
The facility is following its own system; and
The facility's system reasonably relates the intensity of hospital resources to the different levels of HCPCS codes.
The cross-walk to the level of service provided should be available upon request.
Note that in my experience, some private payers do not reimburse for clinic visits, so insurance verification, establishing patient liability, and ensuring patients understand this liability are importtant to the process.
Good Luck!