Oncology & Hematology Coding Alert

Question: When the oncologist performs monthly care plan oversight (CPO) for a Medicare patient with brain cancer, does it matter if he meets the patient face-to-face? What physician activities can we count toward CPO time?

Minnesota Subscriber

Answer: Your oncologist does not need to see the patient face-to-face to report CPO service codes G0181 (Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency [patient not present] ...) or G0182 (Physician supervision of a patient under a Medicare-approved hospice [patient not present] ...). But he must observe some strict rules to report these codes. Medicare payers count only certain activities toward the 30-minute requirement for G0181 and G0182.

These tasks count toward CPO time, according to Medicare (from CMS IOM 100-4 Chapter 12: Care Plan Oversight Services):

- regular physician development/revision of care plan

- review of subsequent reports of patient status, related laboratory and other studies

- communication with other physicians/health professionals not employed in the same practice who are involved in the patient's care

- integration of new information into the medical treatment plan

- adjustment of medical therapy.

But these tasks do not count toward CPO time (although these activities don't count, you should still document these services on your claim):

- time spent with the patient, his family or friends to adjust medication or treatment

- time staff spends retrieving and filing charts

- travel time

- time physician spends phoning prescriptions in to the pharmacist (unless the oncologist and pharmacist are discussing pharmaceutical therapies).

Resource: For more information on CPO billing, go to http://www.cms.hhs.gov/transmittals/downloads/R999CP.pdf.