Codapedia (TM) - The Free Encyclopedia for Medical Reimbursement
Join Our Community Here
It’s FREE!
Learn More about FAST Practice!


General

Author:
Codapedia Editor
Chemotherapy Infusion and E/M on the same day
Citations: No citations found
Resources: No resources found
Total Reviews: 2
Current Rating: ••••••••••

Is it appropriate to bill an E/M service with a chemotherapy infusion?

Here is how Nancy Maguire answered that question:

If a significant separately identifiable evaluation and management service is performed, the appropriate E & M code should be reported utilizing modifier 25 in addition to the chemotherapy administration or non-chemotherapy injection and infusion service.
If a patient presents specifically for a procedure or service and no separate E/M services are provided beyond those necessary for the procedure being performed, it is not appropriate to assign an E/M code or modifier -25.
Example: A patient is seen in the clinic for chemotherapy infusion. The physician discusses the procedure with the patient. The nurse takes vital signs and prepares the patient for the chemotherapy. Should an E/M code be assigned with modifier -25 along with the chemotherapy infusion code?  No, The patient presented specifically for the chemotherapy, and no additional E/M services were provided.

Printable Version

Related Articles
  • Cloned E/M notes
  • Medical Necessity is not Medical Decision Making
  • Doing--and coding--for minor procedures in primary care
  • CODING ARTHROSCOPIC KNEE PROCEDURES
  • Why Get Into Medical Billing?
  • Updating Superbills for the New Year
  • Modifier -25 or -57?
  • Subsequent Observation Services
  • Category of Code Selection
  • Medicare as a Secondary Payer and Consults

  • Click Here to Comment, Clarify and Rate this Article

    JenD
    Tue, Jan/12/2010
    Ratings: ••••
    Chemo Infusin on the same day as office visit
    I think clarification is necessary to address the various scenarious on when it would be appropriate to code an E/M with chemotherapy.

    A interval history and cursory exam are necesasry but included with the pre-service work performed with the procedure (chemo) and therefore not separately reportable as an E/M.

    However, there are many incidents when the provider will need to assess the patient for toxicities, continue care for the underlying disease and treat adverse effects resulting from chemotherapy, port access, etc.

    In these cases, documentation that supports the additional work over and beyod what would be considered normal pre-service work prior to chemo, should be coded with the appropriate e/m.

    pagnard
    Tue, Jan/12/2010
    Ratings: •••••
    Chemotherapy Infusion and E/M
    I totally disagree ! We don't know if the patient can proceed with their chemo tx until we examine and do a interval hx to make sure there is no side effects, anemia, thrombocytopenia, pancytopenia, etc. This is above and beyond a nursing assessment ( 99211) which is included in the chemo administration charges.

    Susie Anderson, CPC Compliance Officer Ft.Wayne Medical Oncology

    Visit The Coker Group
    About Codapedia |  Terms of Use |  Privacy Policy |  Management |  Advertise With Us |  Report Copyright Violation    Follow Us