Oncology & Hematology Coding Alert

Question: Which procedure codes should we report for our oncologist's oversight of hospice patients? Are there different codes and guidelines for Medicare and privately insured patients?

Virginia Subscriber

Answer: For payers other than Medicare, select from two CPT codes, depending on the time your oncologist spent with the patient:

99377 - Physician supervision of a hospice patient (patient not present) ... within a calendar month; 15-29 minutes
99378 - ... 30 minutes or more. When billing Medicare carriers, remember that the physician must spend a minimum of 30 minutes treating the patient. For hospice oversight of a Medicare patient, you should use HCPCS code G0182 (Physician supervision of a patient under a Medicare-approved hospice [patient not present] ... within a calendar month, 30 minutes or more).
 
Furthermore, if you submit G0182 to Medicare for an attending physician who provides treatment and management services of a hospice patient's terminal illness, such as advanced colon cancer (153.x), but wasn't affiliated with the hospice center, append modifier -GV (Attending physician not employed or paid under arrangement by the patient's hospice provider).
 
When the oncologist treats a hospice patient for services unrelated to the patient's terminal condition, and the physician doesn't work for the hospice center, use modifier -GW (Service not related to the hospice patient's terminal condition).