Wiki Chemotherapy teaching

[clopez]

Hello,

I'm new to Oncology and during the E/M audit I have come across encounters billed for Chemotherapy teaching by the NP with 99212. I've researched and found contradicting information where some say its okay to bill for it while others say it's not. I did come across a MCR transmittal from 10-02 That gives this scenario: Based on this can I advise the NPs to bill the Chemo teaching based on time instead of billing all Chemo teachings under same level 99212 Ive also come across where in forums they recommend billing it as 99211... Or if anyone can provide me with updated guidelines set by CMS I greatly appreciated.

C. Selection Of Level Of Evaluation and Management Service Based On Duration Of
Coordination Of Care and/or Counseling.--Advise physicians that when counseling and/or
coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter
or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting
the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3
criteria applicable to the type/level of service provided. However, the physician may document time
spent with the patient in conjunction with the medical decision-making involved and a description of
the coordination of care or counseling provided. Documentation must be in sufficient detail to
support the claim.

EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to
implement chemotherapy. At an office visit the physician discusses the treatment
options and subsequent lifestyle effects of treatment the patient may encounter or is
experiencing. The physician need not complete a history and physical examination in
order to select the level of service. The time spent in counseling/coordination of care
and medical decision-making will determine the level of service billed.

 

[OCD_coder]

This is a confusing area for new to chemo coders. Good question though. The 99211 is used when the RN provides the education as this would be an incident to scenario as the physician would have established the plan of care at a previous appointment.

But if the NP performs the education, they should be documenting the correct time requirements as they can bill incident to or not but according to the amount of time they have spend counseling the patient for the education dominated appointments.

That is where the confusion lies I think.

 

[jaimo]

We are debating right now about this same thing, I have an oncology group who wants the NP to bill for chemotherapy teaching once the physician has already established a plan for chemotherapy and discussed with the patient, to go over the details of the chemo and sign the consent, they want to bill 99214 by time. I found this information from Cindy Parman, CPC, CPC-H, RCC via acc-cancer.org. Has anyone seen this information?
Once patients and physicians have
agreed on a course of care, patients will
receive some form of education prior to
starting the course of therapy.
Some cancer programs perform this service during a
separate patient encounter (e.g., not on the
same day as a patient visit with the
attending physician or on the day the
patient will receive treatment) and incorrectly
believe that it can be separately
charged.
It is important to remember that the
credentials of the healthcare professional
performing the service do not impact
whether this education can be separately
billed to the patient. For example, chemotherapy
education is not considered a billable
event simply because a midlevel provider
personally performs the education session.
It is inappropriate to bill separately for a
service that is considered integral to another
procedure.