Billing for Time Spent on Survivorship Care Plans?

NewOncNurseRN, BSN, RN · Aug 30, 2019

From my understanding on survivorship care plans, they are mostly worked on by the oncologist. That being said, survivors are definitely getting the short end of the stick- I am not sure oncologists are the best at handling all issues such as infertility. Have you looked at the American Cancer Society’s guidelines for care of survivors specifically for primary care providers? There are books for specific cancer types, but those resources might have information on CPT codes as well. Also, the American Society for Clinical Oncologists might have the CPT codes or more information regarding billing time for care planning.

Lane Therrell FNP, MSN, RN, NP · Aug 30, 2019

Thank you so much for pointing me toward these resources.

From where I sit in primary care, I see that the needs of cancer survivors are ongoing over time, and highly variable. This means survivorship care plans would ideally be updated and revisited over time, as the patient ages and progresses through life. Instead, it seems that survivorship care plans are all too often considered to be one-off documents created as a paperwork formality in the immediate aftermath of acute treatment. And patients don't fully appreciate their value, either.

I would truly love to see a shift toward better care for survivors.

DowntheRiver · Sep 8, 2019

As a nurse who does Survivorship Care Plans, I can tell you that the Oncologists definitely do not do them - if only! Actually, I love doing them because I try to go as in-depth as possible. The Oncologist is responsible for delivering them; however, even then as nurses we call the patients and go over the plans with them.

As far as I know, there is no code for billing for SCPs. I doubt there will be in the foreseeable future.

As for updating them, I don't really see the need. The SCPs we do provide an overview of their treatment, diagnosis, staging, co-morbidities, surveillance, and follow-up. If we tried to keep them open for years to come we would be inundated with requests for updates. The patient is encouraged to share them with their PCP so once they're discharged from Oncology follow-up their PCP has this info as well.

As a survivor, I would love to see better long term care for survivors as well. I had HL at 22 and now 10 years later am still dealing with some long term consequences as the result of treatment. I'm lucky I'm an Oncology nurse or some things might have been overlooked.

Lane Therrell FNP, MSN, RN, NP · Sep 12, 2019

On 9/8/2019 at 12:32 PM, DowntheRiver said:
The patient is encouraged to share them with their PCP so once they're discharged from Oncology follow-up their PCP has this info as well.
As a survivor, I would love to see better long term care for survivors as well....now 10 years later am still dealing with some long term consequences as the result of treatment. I'm lucky I'm an Oncology nurse or some things might have been overlooked.

Thank you so much for this response. Your patients are indeed lucky to have you! I have noticed, too, that the oncologists are not as engaged as I wish they could be in survivorship concerns. Unfortunately, the "encouragement to share (survivorship plans) with their PCP" rarely happens, and even more rarely do the PCP's give survivorship plans any attention if and when they are shared. Patients are lucky if they bring in a survivorship care plan and their PCP makes the effort to scan it into their chart. And then it sits there, never to be noticed again. Yet we all know (or SHOULD know), the consequences of cancer treatment are lifelong. And the idealist in me says we shouldn't all have to be Oncology nurses to receive the right attention and treatments. I recently worked with a private health coaching client who survived a rare facial-nerve neuroma "successfully" treated with radiation 15 years ago. I use quotation marks around the word successfully because her sequelae-related symptoms (incuding partial facial paralysis and vagus nerve involvement) are worsening with age. She recently destroyed the documents relating to her treatment in an effort to clean up her home. In this case, the patient did not have a survivorship plan, nor did she understand the value of maintaining her own records to share with future providers. No one had ever taken the time to help her understand the potential long-term sequelae of her treatment or how to engage in self-management or self-advocacy.

nurseteni · Oct 16, 2019

I'm like wow...there are oncologists who complete SCPs?!? Lol. As an Oncology Nurse who completes SCPs and is a member of the CoC council for my facility, it is my understanding that organizations may be moving away from completing SCPs as a mere formality (in alignment with satisfying CoC accreditation). Apparently, CoC will no longer mandate the completion of the SCPs and will require that comprehensive services be offered for survivors rather than a document that may, or may not, see the light of day after the initial skim-through. Having worked in a major cancer center previously and now, in a local community hospital, I'm glad to see this much-needed change finally reaching the community hospital setting. The sequelae referenced above is a wonderful example of why the survivorship care program push is absolutely necessary.

https://www.facs.org/~/media/files/quality programs/cancer/coc/draft_coc_revised_standards_may2019.ashx

Bottom line: I think the needs of the survivor will be much better addressed in the near future.

DowntheRiver · Nov 19, 2019

Do any of you work in Survivorship Clinics? I'd be interested in some professional contacts of nurses on the outside who work in Survivorship Clinics or who work on treatment summaries/care plans.

nurseteni · Nov 21, 2019

We'll be creating a "survivorship clinic" (quotation marks only because I'm not sure what it's going to look) starting in 2020. I'd guess we may have a slight bit more clarity following our CoC Survey in Spring of 2020.