Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

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Medical Oncology Code Changes

ACOA Coding Minute

Which Doctor?

The guidelines on completion of theCMS-1500 claim form total 78 pages of instructions, and are listed at:

http://www.cms.hhs.gov

These instructions provide step-by-step and field-by-field instructions for paper and/or electronic claims filing.  Whether the claim is submitted by a third party billing company or by the provider’s office staff, the information must be correct and complete.  One item that affects oncology practices is the directive for the completion of field 24k (Reserved for Local Use):

“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.”

Based upon these guidelines, the physician who was present supervising the delivery of radiation each day is listed on the corresponding line item for that delivery code.  For example, if Dr. A supervised treatment delivery Monday, Wednesday and Friday, and Dr. B was the physician on site for Tuesday and Thursday, there would be a different PIN number listed for each treatment delivery line to represent the physician who was actively supervising therapy.

It is important to recognize that these claim form completion requirements do not affect hospital charges reported on the UB92 form, but only services performed and billed in the office or freestanding center.

Watch for more 2005 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates from the Academy’s Website.

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-Hcparman-7484537
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.  

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