Wiki 77427 on treatment visit

[JM.Geyer]

Ok all you fellow coders out there. I'm begging for help on this matter. I know for a fact that my NP can't see a pt and charge this code. Even though my Radiation Oncologist does 3 of the 4 elements to this code. I have referenced my CPT manual, ASTRO guidelines, CSI guidelines, and have gone to 2 seminars where the presenters both stated no can do. The provider is the one who needs to being doing this visit. My Radiation Oncologist even went to a seminar this past Feb. and was told the same thing, he however insisits on letting this continue. He now is asking that we not bill for that visit until he signs off on what the NP did, which still is wrong. I am now to the point where I want no part of even coding out the visit for fear of losing my CPC and ROCC certifications. I have tried calling the Insurance Commisoners and they tell me they know nothing about the codes. Who else out there can I goto for help?

 

[Stacyharter98]

You could talk with the patients individual insurance companies. In doing so, they would probably conduct an audit of the practice.

 

[hodgeskm]

Cpt 77427

If you are coding in a practice that has a compliance/ethics office, discussing with an officer from that entity is a good idea.

Your e-mail doen't indicate if your Radiation Oncologist is the sole owner of the practice, or if he has partners, or is employed physician. I'd think others related to the practice would desire to mitigate patterns of risk.

Another source of info on CPT 77427 is the AMA CPT Online Knowledge Base - try accessing KB# 1253, 1252, 1251. These are very clearly written and address this topic directly. Providers have the responsibility to provide the services as defined by CPT (but you know that already!!!)