Oncology & Hematology Coding Alert

Experts clarify Medicare guidelines If you want to get your oncologist paid for E/M services and minor surgical procedures he performs in a teaching setting, you should know Medicare's documentation and supervision requirements for the teaching physician rules, coding experts say.
 
When your oncologist works as a "teaching physician" (TP) and supervises a resident's services in an office or hospital setting, you will have to report your physician's work using the teaching physician rules, according to the Medicare Carriers Manual (MCM), section 15016.
 
The MCM defines residents as an intern or fellow who's enrolled in an accredited graduate medical education (GME) program, says Marti Geron, CPC, CMA, CM, coding and reimbursement manager at the University of Texas Southwestern Medical Center at Dallas. To appropriately report services under the teaching physician rules, make sure your resident meets Medicare's definition.
 
Experts offer four field-tested strategies for reporting E/M services and minor surgical procedures using the teaching physician rules. 1. Report Office Consults Based on 'Key Portions' You can report E/M codes if the TP personally furnishes the E/M service, such as an office consultation (99241-99245), without the resident present, said Jillian H. Kuruc, MHA, CPC, CCS-P, a clinical technical editor with Ingenix Health Intelligence in Binghamton, N.Y., during a session on the teaching physician rules at the Third Annual Coding, Billing, and Compliance Essentials Conference in Orlando, Fla.
 
If the resident also performed this E/M service, your oncologist would have to duplicate the "critical and key portions" of the resident's services to bill under this guideline, Kuruc tells Oncology Coding Alert. The TP should define - and be able to defend - those critical and key portions, she adds.
 
For example, a primary-care physician (PCP) requests an opinion on a patient with enlarged lymph nodes. The TP considers the lymph node exam a critical portion of the patient evaluation. The resident evaluates the patient, and
based on the findings, diagnoses the patient with chronic lymphadenitis (289.1) and recommends a treatment plan. The resident bills the visit as 99243 (Office consultation for a new or established patient ...).
 
The TP also evaluates the patient's lymph nodes, performs a detailed history and physical exam, and discusses possible treatment options with the patient. But Medicare requires that the attending physician only document that he or she performed the office visit's critical portion, and that the physician directly cared for the patient.
 
The TP doesn't have to duplicate the resident's progress notes, but should refer to the resident's notes and state that the TP reviewed the resident's medical documentation and agrees with the diagnosis, Geron says.
 
If the resident did not attend the oncologist's evaluation of the patient, and also didn't perform a complete E/M service, your physician must bill and document [...]