Oncology & Hematology Coding Alert

Question: We are a freestanding clinic next to a hospital. Our medical oncologist is a contracted hospital physician. Can he bill Medicare for services provided in our office by our nurse if an emergency room physician (who is not on the premises) acts as the supervising physician?

New York Subscriber

Answer: You must first determine whether your practice is hospital-based or a physician office. Some oncologists have offices in hospital buildings and either use their employees to administer chemotherapy or use facilities or supplies for administration.

If the physician uses hospital employees or facilities for chemotherapy services, he cannot bill. To consider chemotherapy as office-based, the oncologist must administer it:

1. In an office that is leased to the physician and not in a hospital outpatient department area;

2. Using nurses employed by the physician; and

3. With the physicians supplies and equipment

It is important to note that some non-Medicare payers and certain Medicare carriers may impose more requirements.

If the above are met, Medicare requires supervision of services, including administration of drugs and fluids provided by a nurse or other nonphysician. This is covered by Medicare as services incident to a physicians. The rules for incident to require that a physician must be present in the office and immediately available to provide assistance when services are furnished.

The physician who is present does not have to be the patients personal physician but can be another member of the group practice. In this case, the emergency room physician, who is in a separate building, does not meet this requirement.