Reader Question: 77370 for Counseling   (August 2001)

Question: Can we bill more than one special medical physics consult (77370) during a patients course of treatment?Kentucky Subscriber
 Answer: Generally, 77370 (special medical radiation physics consultation) is billed once per course of therapy for the additional work performed by the physics staff. There are rare exceptions to this general practice, such as when two different modalities – external beam followed by brachytherapy – are used to treat a patient. Code 77370 should be used for consultations when a [...]

Turn a Losing Proposition Into a Winner: Know Which Oral Chemotherapy Drugs Are Reimbursed and Whom To Bill   (July 2001)

Reimbursement for oral chemotherapy can be a losing proposition because Medicare has a long-standing policy against paying physicians for self-administered drugs dispensed in the office. However, a few oral chemotherapy drugs are eligible for reimbursement in this situation. The key to getting paid is knowing which drugs can be administered in the office, which entity you should submit the claim to – your local carrier or durable medical equipment regional carrier (DMERC) – and which codes to [...]

Documentation Is Critical for Higher-Level Office Visits   (July 2001)

Oncologists are losing money because they improperly code their more-than-routine visits. And, to bill legitimately an E/M higher than 99211, they must also strive for improved documentation that establishes the medical necessity of the more detailed visits, says Dianna Hoffbeck, RN, CCM, HCFE, president of Northshore Medical, a coding and medical billing firm in Atlantic City, N.J. 
Practices generally use 99211 to report “incident to” physician services for patients who visit the office for chemotherapy-related care. [...]

You Be the Coder: Pump Refills   (July 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
 
Question: How should I bill for chemotherapy pump refills in the outpatient hospital setting? Should I report code 99211 for the nursing time (which is minimal) and the J codes for the drugs?
 
Maryland Subscriber 

Answer: If the physician refills the pump in the outpatient hospital setting, report 96520 (refilling and maintenance of portable pump) or 96530 (refilling [...]

Some Commercial Carriers Still Reimburse 96545   (July 2001)

Medicare has made code 96545 (provision of chemotherapy agent) virtually useless because it won’t pay for the service separately from chemotherapy administration. But some commercial payers still pay for providing and administering the drug and reimburse for the drug itself. So, oncology practices should continue to consider billing drug provision with commercial payers.
 
Choosing a Billing Option 
 
Medicare will pay for 96545 separately only if oncology practices use it instead of the J9xxx code for reporting the [...]

Reader Question: Chemo Tray   (July 2001)

Question: We have not been charging for supplies such as Huber needles, Buretols, gloves, syringes and tubing, but would like to start for the commercial payers.  Are most practices using 99070 for “chemo tray,” or using A codes for specific items?
 
Georgia Subscriber
 
Answer: Medicare generally does not make a separate payment for disposable supplies used in a physician’s office because it considers supply costs covered under chemotherapy administration, 96400-96549, and/or therapeutic infusion, 90780-90781. 
 
Medicare reimburses supplies [...]

Reader Question: CT Scan Guidance   (July 2001)

Question: When is it appropriate to bill 76370 for CT scan guidance for radiation treatment planning? Also, Medicare recognizes modifier -26, which pays about $45. Can we charge this fee if the CT scan is ultimately used for a 3-D simulation, 77295? What documentation of service is required and are there any restrictions?
 
Maryland Subscriber
 
Answer: Whenever a CT scan is required to get tumor specifications for radiation therapy planning, it is appropriate to bill 76370 (computerized [...]

Reader Question: Inpatient Chemotherapy   (July 2001)

Question: When is it appropriate for a physician to bill for inpatient chemotherapy, 96408-96412?
South Carolina Subscriber
Answer: There are no circumstances in an inpatient environment that would allow the physician to bill chemotherapy, 96408-96412. According to Medicare, these codes are for administering chemotherapy drugs in an outpatient setting only and physicians cannot use them because they imply that hospital staff administer the agents, the service takes place in a hospital room, and the facility provides the [...]

Determine When To Use Prolonged Service Codes for Extra Time   (June 2001)

When an oncology-related visit takes longer than normal, codes +99354-+99355 used to describe a prolonged visit with face-to-face physician-patient contact are appropriate as long as the circumstances and services that resulted in extra time spent can be proven. In contrast, these codes should not be used for an extended visit that includes routine services. There has to be face-to-face contact with the patient where the disease is discussed, says Dianna Hofbeck, RN, CCM, [...]

Reimbursement for Simulations Depends on Careful Documentation and Medical Necessity   (June 2001)

The key to getting paid for simulations in radiation oncology no matter how many are performed is documenting all changes in the treatment field. Otherwise, payers will have a difficult time determining the medical necessity of multiple simulations, says Jim Hugh, MHA, senior vice president with AMAC, a reimbursement and billing firm based in Atlanta. In addition, a high reimbursement rate is associated with three-dimensional simulations (77295) and its tempting for physicians to [...]