Specialty Groups — Oncology
HCPCS code G0175
In certain situations it is possible for a hospital to bill HCPCS code G0175, which is defined as “scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present.” According to Chapter II of the OPPS Manual: “Hospitals can use HCPCS code G0175 in reporting a scheduled medical conference with the patient involving a combination of at least three health care professionals, and one of whom is a physician, but cannot be a nurse.” The Medicare Intermediary Manual further discusses a multidisciplinary approach to rehabilitation and states that the multidisciplinary team in this venue is comprised of the physician, rehabilitation therapists, psychologist and/or social worker, and rehabilitation nurse(s).
Therefore, the key requirements for billing this service include:
There must be at least 3 members of the multidisciplinary staff present at the meeting, and
One of these individuals must be a physician, and
None of these three individuals can be a nurse (nurses may be present in addition to the other members of the multidisciplinary team, but at least 3 team members must represent disciplines other than nursing), and
The patient must also be present for the interdisciplinary conference.
Based upon the requirement that the patient must be physically present during the team conference, hospitals should make certain that HCPCS code G0175 is not assigned for tumor board meetings or other staff conferences that do not include the patient.
Reprinted with permission from the Journal of Oncology Management Jan/Feb issue.
Cindy C. Parman, CPC, CPC-H
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association. She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.