You are seeing a patient as an outpatient consultant for support and cancer-related pain in the setting of non-small cell lung cancer. After spending 30 minutes with him, he leaves abruptly to get to his oncologist appointment. Which of the following is true?
A. The most appropriate primary International Classification of Diseases (ICD) diagnosis code for this encounter is non-small cell lung cancer.
B. To document complexity of an encounter using time, a provider must describe and document how at least half of the minutes were spent counseling and coordinating care.
C. When billing an outpatient visit using time, a provider can include the preparatory time spent reviewing the chart, most recent labs, and coordinating with the oncologist prior to the visit.
D. Coding and reimbursement for each palliative care encounter are more complex than it is for other specialties, requiring a service code, diagnosis code, and an advance care planning code.
Correct answer: B
When supporting an E/M code using time-based billing, it is necessary that more than 50% of the minutes are spent in counseling and in care coordination. Time documented during inpatient encounters can include the time in preparation and care coordination while on the unit-floor including chart review and discussion with other care providers. Outpatient time must all be spent face-to-face with the patient (answer C). Choice A is incorrect for this encounter given patient is receiving same-day concurrent care with the oncologist provider. It is likely that the oncologist will bill using the NSCLC code. It would be more appropriate for the palliative care physician to bill using a symptom-based ICD code such as neoplasm-related pain rather than the cancer-diagnosis. Coding and reimbursement for palliative care physicians are no different than for other medical specialties (answer D). The code for each encounter must contain two parts: a procedure/service code (E/M) and a diagnosis code (ICD).
FAST FACTS AND CONCEPTS #48 CODING AND BILLING FOR PHYSICIAN SERVICES IN PALLIATIVE CARE – Charles F von Gunten MD, PhD
