Oncology & Hematology Coding Alert

Question: A patient came into our multiphysician oncology practice for her monthly chemotherapy treatment. Her oncologist was on vacation, so another physician supervised her treatment, while a physician assistant administered her chemotherapy. Can we bill the incident-to under the second doctors provider number?

Georgia Subscriber  

Answer: Yes, in your office setting, you can bill the incident-to services under the second physicians provider number. The supervising physician for the incident-to service is not required to be the same physician who initially saw the patient, nor does the supervising physician have to be of the same specialty as the initial physician. The physician assistant, however, must be an employee of the physician or physician group.
 
To bill incident-to services under a physicians provider identification number (PIN), you must be sure the services are for an established patient. If he or she is new or presents with a new problem, you must bill under the physician assistants number.
 
In addition, the physician must provide direct personal supervision over the services rendered while in the office. You cannot bill incident-to if the physician is in the hospital but only available by phone. The physician is not required to be in the same room at the time of service but should be in the office suite. For example, if the patient develops nausea (787.01, Nausea with vomiting) during the chemotherapy treatment, the physician assistant could seek the oncologists advice, and the oncologist could assist the patient face-to-face, as opposed to over the phone.
 
Advise your physician assistant to document in the progress notes or patient charts the name of the physician who supervised the service. These notes let anyone reviewing the claim know that your physician assistant was aware of the physicians supervision and show that youre billing incident-to services appropriately. Medicare auditors are now checking copies of office schedules, so make sure your physician assistants documentation matches the schedule, indicating that, again, youre billing incident-to correctly.
 
For Medicare or other carriers to reimburse your oncologist in a hospital setting, your oncologist must personally perform the incident-to service.