CPT Code 96413

leoraha@yahoo.com

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It says in the CPT 2016 Coding book regarding a code 96413 that it is not intended to be reported by the individual physician or other qualified health care professional in the facility setting. What happens if the patient was inpatient, how do I bill this code to get paid?
Thanks,
Leorah
 

thomas7331

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96413 is not a physician service code - this is for reporting 'incident to' services performed by ancillary employees. If this was performed in a facility, the hospital would charge for this on the inpatient or outpatient UB claim since it would be done by their employees - there would not be a separate professional bill for this.
 

leoraha@yahoo.com

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Not sure what code to use then

Since 96413 is only for 'incident to' services but the doctor provided chemotheray aministration, and the doctor is private and does not get paid by the hospital how can he get paid for the service he provided to the patient? Is there another code to use?

Any help will be greatly appreciated:)
 

thomas7331

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If the physician is just seeing the patient in the hospital setting and managing their condition, then an E&M code might be appropriate. If the physician is personally performing the chemotherapy, I'm not sure what to tell you - it would not be a normal situation for a non-employee to be doing this because the performance of the administration and supervision of the staff would be the hospital's responsibility. I wouldn't expect a physician to be independently billing for this - that might be something the physician needs to discuss with the hospital?
 
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