Medical Oncology Code Changes
ACOA’s Coding Corner – June 2006
Which Doctor?
Medicare requires that freestanding or office-based infusions and/or radiation treatments be reported with the correct supervising physician. For all services performed “incident to,” a physician must provide direct supervision (be in the office suite and immediately available to provide assistance and direction). According to the CMS 1500 claim form completion guidelines, the physician reported on the claim form is the physician supervising that day, not the physician of record for the case.
Item 24K – Enter the PIN (the NPI will be used when implemented) of the performing provider of service/supplier if the provider is a member of a group practice. When several different providers of service or suppliers within a group are billing on the same Form CMS-1500, show the individual PIN (or NPI when implemented) in the corresponding line item.
In the case of a service provided incident to the service of a physician or non-physician practitioner, when the person who ordered the service is not supervising, enter the PIN (or NPI when implemented) of the supervisor in item 24k.
http://new.cms.hhs.gov/manuals/downloads/clm104c26.pdf
For example, the patient was initially seen by Dr. A, who prescribed infusion services over a period of three days. The first two (2) infusion services were performed while Dr. A was supervising, but for the third infusion, Dr. A was at another location and the infusion was supervised by Dr. B. The claim form would list Dr. A for the first two service dates and Dr. B as the supervising physician for treatment number three.
Watch for more coding changes in the upcoming months. Review previous Coding and Reimbursement Updates.
This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.
Phone: (877) 6CODING
Fax: (770) 445-0407
[email protected]
www.codingstrategies.com
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.