Oncology & Hematology Coding Alert

NPPs are vital to many offices' chemotherapy 'teams'

A qualified nonphysician practitioner (NPP) can fill many roles in an oncology office; one area that NPPs help with extensively in many offices is patient and family education for chemotherapy patients. Using NPPs in this role is smart and efficient, experts say.

How? Once the MD sets up the protocol, the NPP comes in and does chemo teaching with the patient and family. This allows the patient and family an opportunity to get to know their NPP and vice versa, according to a compliance specialist at a large Boston practice who declined to be identified.
 
Consider this example: Let's say Dr. A is the plan-of- care author for Patient X, who has leukemia and will start chemotherapy in a few weeks. One Monday, Patient X reports for chemotherapy education with the nonphysician practitioner. Dr. A is away at the hospital, but Dr. B is in the office suite and immediately available to help should the need arise.
 
The NPP answers several questions regarding the course of treatment and performs some counseling to calm the patient's anxiety about the care plan. The entire visit takes 12 minutes.
 
On your claim, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) incident-to Dr. B.

Remember: You must report 99212 incident-to Dr. B, not Dr. A; you must report the service incident-to the physician who is in the building. When coding for this scenario, CMS instructs coders to also:
  report the service under the same group PIN as you would for Dr. A, and make sure you have a signed form 855R reassigning his right to bill to the group.
  identify the supervising physician (Dr. A) "in 2310B loop."
  list the supervising physician's (Dr. A's) PIN in REF02 and the IC qualifier in REF01. Heads-up: When there's no "suite of rooms" in the office, the supervising physician must actually be in the same room as the supervised provider, the CMS transmittal states. The Medicare Internet Only Manual (IOM) also states that availability by cell phone or pager is not acceptable - the physician must be in the office suite.