Oncology & Hematology Coding Alert

   
   
Check your documentation for the oncologist's role before you code If you think oncology practices don't have to bother with supervision requirements, think again. You shouldn't report a number of imaging services crucial to cancer treatment unless you-ve verified that the physician provided either general, direct or personal supervision.

If you have to code the technical component for any of the following codes, be sure you double-check the supervision requirement:

Read Up on Requirements In most cases, if the physician doesn't directly provide all services a patient receives, you must nevertheless document a minimum level of physician supervision. The extent to which the physician must supervise nonphysician staff varies by procedure. CMS has designated three principle levels of physician supervision:

Level one: general supervision. -General supervision means the procedure is furnished under the physician's overall direction and control,- says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. -But the physician's presence is not required during the procedure.- The physician must order the test and document medical necessity but does not have to be in the office at the time of the performance of the test, she says. The physician is responsible for training the people who do the tests, ensuring that they remain current with their education, and maintaining the testing equipment.

You need general supervision for 76950-TC.

Level two: direct supervision. This means that in the office setting the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the procedure. The physician doesn't need to be present in the room during the procedure.

Verify direct supervision for 76370-TC and 76873-TC.

Level three: personal supervision. In this case, the physician must be present in the room during the procedure to offer hands-on assistance and direction or to directly perform the service.

For a level-three service, the physician -must be physically in the room with the patient and the NPP [nonphysician practitioner] providing the service. He or she cannot be across the hall with another patient or making phone calls at the front desk,- Mac says.

Double-check the record for personal supervision for 76965-TC.

Tip: You can find the required supervision levels for all codes by looking to column -Z- (-Physician Supervision of Diagnostic Procedures-) of the Physicians Fee Schedule database, available at www.cms.hhs.gov/physicians/mpfsapp/step0.asp or www.cms.hhs.gov/physicians/pfs/default.asp. Seize the Chance to Prove Doctor's Role CMS is vague about how to demonstrate you-re not breaking the rules. The policy says, -Documentation maintained by the billing provider must be able to demonstrate that the required physician supervision is furnished.- Translation: You and your physician must make sure you have thorough documentation in place.

What to do: Meet with your physicians to [...]