Wiki Chemotherapy Physician Charge Clarification

East Windsor, NJ
Best answers
Hello All.

I was hoping someone could help clarify a scenario at my job. I work for an outpatient Cancer Center that is part of a hospital. One of the physician's questioned how the company that handles his professional billing can successfully bill and be reimbursed for observation of the Chemotherapy that he orders. Be aware that he is not employed by the hospital, which would explain why he bills his own professional charges. Initially, they were billing Observation codes 99235 and 99236, which I do not believe accurately describe the service and are clearly bundled to the Chemo admin 96413. This tells me that the payment for the observation is included in the payment for the administration. I thought about billing separately for the Professional and Technical components, but Chemo admin codes seem to be strictly bundled as global codes. Is there any way to split the services or bill an additional code to get the physician reimbursed for Chemo observation? Any suggestions or guidance would be greatly appreciated. Thank you for your assistance.

Mark P Presti, CPC-A
No there is no way to bill for physician observation of chemo admin performed in the facility. This would be a facility charge, the observation is a part of the administration performed by facility staff. Nth presence of the physician is not required for the admin. With no other medical necessity then the physician presence is courtesy.
Agreed. Our physicians practice is owned by the facility but they do not charge for chemo observation either. It is inherent that there must be a physician that provides supervision to the chemotherapy suite. There is not a billable charge that I am aware of.