Ob-Gyn Coding Alert

Question: A patient receives chemotherapy in an office setting. Must a supervising physician be physically present during the therapy in order to bill an "incident to" service?

Arkansas Subscriber

Answer: No, the ob-gyn (supervising physician) doesn't have to be physically present in the treatment room while the patient is having chemotherapy (such as, 96413, Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). The ob-gyn must be present in the immediate office suite,however, to render assistance if needed.

Alternative: If the ob-gyn is a solo practitioner, she must directly supervise the care. If the ob-gyn belongs to a group, she or any physician member of the group may be present in the office to oversee the service.

Under Medicare guidelines, some carriers have stated that you should put the supervising physician's NPI (National Provider Identifier) on the claim form rather than the primary physician's number. Check your carrier's rule first in order to be sure what applies to you.