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Oncologist not employed with hospital

  1. #11
    Exam Training Packages
    I agree Laura which is why i have been holding off on telling him that i can't bill any of his services. I understand that the hospital should be billing the administration codes because the nurses are employed by them, but if we hire nurses then we should be billing those services and the hospital bill for the drugs. What i don't understand if what can i bill for in the mean time ?? My physician is on the floor in and out the chemo room's through out the day. He is monitering the patient's as well as supervising the nurses. He is not there the entire time like the nurses but he is there i would say at least half of the time. I have read that you cannot bill an E/M visit the same day as chemo unless of a complication or something then you use a -25 but someone told me i could bill on Observation E/M as long as the physician document's.

    Also i have another thread posted. In the CPT book the section before the chemo codes there is a statement that states " Codes 96401-96402,96409-96425 etc. are not intended to be reported by the physician in the facility setting" What is defined as a facility setting ? We bill POS 22 but our clinic is located in the hospital because of the equipment used. Does this mean a physician can't bill these services at all ?? That doesn't sound right with me because how are they billing in private practise ?

  2. #12
    Columbia, MO
    "In private practice".. If you are meaning in the physician office then it would not be in a facility setting and the physician would use the chemo admin codes to reflect the resources consumed in his office. If you are billing place of service 22 then that is facility outpatient and that is a facility setting. I assume the facility has an outpatient infusion unit where these services take place, that is the facility setting. If you run a clinic operation in the facility and use facility provided resources then that is a facility setting. I understand that your physician runs in and out of the rooms on the infusion unit but there is no way he can charge each individual patient's payer for activity he is providing for a group of patients all at one time, which is essentially what is happening. He is probably seeing other patients in the clinic at the same time that he does charge for. There is no observation code that can be used and charged for this activity. The chemo admin codes are for the administration of the chemo and that is the nurses which are under the authority and supervision of the hospital. If you hire your own nurses that if fine then you will need to have them administer the chem in YOUR office setting POS 11, and then you can charge the administration charges, However, I doubt the hospital will supply the drugs for you as there will be no way for them to charge, they are not a dispensing entity and cannot charge for the dispensing of the drugs for others to use. If you want the reimbursement then you will have to hire chemotherapy trained nurses and order the drugs and administer this within your own office setting. I know physician that have taken this on and they like it, but it can be quite the expense.

    Debra A. Mitchell, MSPH, CPC-H

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