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Oncology coding question

  1. #1
    Default Oncology coding question
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    In the CPT manual under the Chemo section the statement " These codes are not intended to be reported by the physician in the facility setting. Can someone please clarify what this means ??

  2. #2
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    In the facility setting it is not the physician or his/her staff administering the chemo it is the facility staff.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    So the facility should be using those codes and not the physician ??

  4. #4
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    Yes, and the facility coder typically does not code those as they come from the chargemaster via charge codes entered byt the staff on the chemo unit.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    So can my physician charge an E/M visit since he isn't billing for the chemo ?? What other services may he bill for ?? Also, would you know where i can get something in writing saying the Facility should be billing this ?? I spoke with someone at Provider Relations and they said my physician should be billing this so i need something in writing.
    thanks

  6. #6
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    you can find this in the medicare regs but I do not have that link, look under billing physician services on the same day as chemo administration for starters. But no he may not bill a visit level on the same day as the chemo.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Yes i have the link stating about the e/m visit on the same day but i was really looking for something stating that we could not bill the administation codes since we don't employ the nurses or supply the drugs. Thanks

  8. #8
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    What would be defined as a facility setting ? My physician has his oncology office in the hospital but all his claims are billed out with pos 22. His clinic is inside the hospital because the clinic office's are not equiped enough.

  9. #9
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    The it is not his clinic if you are billing POS 22. If he pays rent and pays the staff salary, and buys the drugs then he can bill the admin with POS 11. But if the facility supplys the clinic space for the convenience of the physician and supplies everything else the the facilty gets to bill the admin.

    Debra A. Mitchell, MSPH, CPC-H

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