Geriatric assessments

[trarut]

Oh wise ones I have a physician asking how to bill for a geriatric chemo toxicity score or eprognosis she is doing using a CARG calculator. She wants to bill it as a prolonged service (99354). Anyone heard of this and/or doing this?

Thanks!
Tracy

 

[SharonCollachi]

The Geriatric Chemo Toxity Score is a set of 11 questions for the provider to answer, and than a score is automatically calculated (here is a website that will calculate for you). It truly should not take more than five minutes to do, and I would say less than that.

Here is a website of eprognosis calculators, but I do not see the CARG there. Looking at the calculator for outpatients with advanced cancer, it is 6 questions. That should take 3 minutes at the most, including time pulling up the website.

I'm not seeing enough time for prolonged service, and it looks like it probably should be bundled into the E&M visit.

 

[trarut]

Sharon, are you aware of any other CPT code for this type of assessment? My provider has indicated it takes approximately 30 minutes to complete the assessment using the CARG and a JCO Oncology Practice article I read says it usually takes 15-30 minutes. I'm not adverse to using a prolonged services code if it's applicable and supported but if another code exists, I'd prefer to use that (obviously) but haven't been able to find it.

 

[SharonCollachi]

I was thinking about end-of-life care planning, as there is a code for that, but it's only face-to-face time. What is the provider using the assessments for?

 

[trarut]

It's an additional/more in-depth risk assessment in older patients receiving chemotherapy. This is time spent face-to-face with the patient, working through the assessment and discussing the results.