Wiki New to Oncology!

[Bea024]

I have a physician who wants to bill an admission 99222 everytime he writes orders for a tranfusion or outpatient chemo treatment at a hospital. Patient is usually in/out the same day so it doesn't sound right to me. Please Help! He is not physically there he just sends the orders...

 

[alannae]

If the patient is not 'inpatient' and the physician is not going to the hospital, then he cannot bill inpatient codes. He needs to be educated on the coding requirements.

 

[lcashburn]

I wanted to add something here...most of the big oncology settlements by the OIG for abuse and/or fraud cases in the past few years have been regarding physician E & M charges for chemotherapy patients. If you follow the link it will take you to where the cases are posted on a daily basis, and in the right column there is a place where you can sign up for daily emails. Of course they will be from all over healthcare, just delete the ones you don't want. But there are some serious penalties for inappropriate claims like this so your physician needs to be made aware that even if the intention is not to bill fraudulently, the codes submitted must match the services performed. http://oig.hhs.gov/fraud/enforcement/criminal/index.asp
Here's the biggest case from last year: http://falseclaimsactattorney.com/2...-million-settle-medicare-over-billing-claims/

 

[davidsnk]

He cannot bill a 99222 for that. Unless he has a face to face with the patient, he cannot bill any E&M.

If the patient is an outpatient, and he see's the patient and documents, then he can only bill an outpatient visit, if 23hr, a 23hr code and if in-patient, an inpatient code.