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Outpatient chemotherapy question

  1. #1
    Default Outpatient chemotherapy question
    Medical Coding Books
    Hello,

    We have an outpatient service dept at our hospital where our Oncologist see's patients and chemo is administered. If a patient just comes in for chemo therapy and doesn't have an appointment with the Oncologist, our Oncologist wants to be reimbursed for being there and supervising the chemo incase of patient reaction etc. Can we charge for his time and supervision. Right now we charge the 96413 (technical fee only)...can we charge a professional fee also?

  2. #2
    Location
    Columbia, MO
    Posts
    12,841
    Default
    the 96413 is the administration fee which the facility will charge. There is no charge for the physician to just supervise the chemo in the outpatient setting.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    NCF Gainesville
    Posts
    64
    Default
    Agree! If he wasn't there to supervise, the facility wouldn't be able to be bill either.

    Jeni
    Jeni Smith, CPC, CPMA

  4. #4
    Location
    Columbia, MO
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    12,841
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    Quote Originally Posted by jas0426 View Post
    Agree! If he wasn't there to supervise, the facility wouldn't be able to be bill either.

    Jeni
    No the facility would bill the chemo and the admin charges even if that physician were not there. They do not need each physician to be there to supervise chemo for the facility to be able to bill the charges. The admin fee is for the nurse to admin the chemo and the facility is providing the drugs, there is nothing for the physician to be charging as it is all facility resources being used. The physician cannot charge an E&M either since this is scheduled chemo and the patient is getting the services they are scheduled for. If the chemo is being delivered in a physician office then the provider must be onsite to supervise and the admin charges are billed for the physician's nurse to administer the chemo.
    Do not confuse the rules for physician billing with the facility as they are different.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Thank you for the information. That confirm the information that we received. Dr. Gibbs is usually onsite while the chemo is being administered.

  6. #6
    Default Part 2 :o)
    There is a work RVU's associated with the code 96413, so what would the physician have to do in order to charge or to get the RVU's associated with the 96413? Would he have to start the IV infusion? Is there something he could document that he could get the profee?

    Any information would be greatly appreciated!
    Becky

  7. #7
    Location
    Columbia, MO
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    12,841
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    The work RVU gores to the facility as it is their nurse that is performing the work, the physician cannot charge for ordering this service nor for being in the facility while it is being performed

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Location
    NCF Gainesville
    Posts
    64
    Default
    Quote Originally Posted by mitchellde View Post
    No the facility would bill the chemo and the admin charges even if that physician were not there. They do not need each physician to be there to supervise chemo for the facility to be able to bill the charges. The admin fee is for the nurse to admin the chemo and the facility is providing the drugs, there is nothing for the physician to be charging as it is all facility resources being used. The physician cannot charge an E&M either since this is scheduled chemo and the patient is getting the services they are scheduled for. If the chemo is being delivered in a physician office then the provider must be onsite to supervise and the admin charges are billed for the physician's nurse to administer the chemo.
    Do not confuse the rules for physician billing with the facility as they are different.
    Agreed they are different. But for Outpatient, Provider Based infusion centers, facility services can only be billed "incident to" a physicians service. So physician supervision is required. They don't need to be in the room directly, but must be immediatly available. I might not have understood what you are trying to say, but maybe this will explain my thoughts better:

    "Direct Supervision for Off-Campus PBDs Has Not Changed
    CMS finalized without modification its proposal that, for off-campus PBDs, the physician or non-physician practitioner must be present in the off-campus PBD and immediately available to furnish assistance and direction throughout the performance of the procedure. The preamble points out that the direct supervision requirement for off-campus PBDs has not changed and reiterates long-standing policy that while the physician or non-physician must be in the off-campus PBD, the physician or non-physician practitioner does not need to be in the room where the procedure is being performed. Accordingly, a physician in a physician office would not meet this location requirement for an off-campus PBD in another part of the same building."
    Jeni Smith, CPC, CPMA

  9. #9
    Location
    Columbia, MO
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    The poster stated this was an outpatient department in the facility. Not a provider based off campus clinic.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    NCF Gainesville
    Posts
    64
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    That explains it...lol.
    Jeni Smith, CPC, CPMA

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