Chemo teach (98960)

Our MD/NP's speak with the patients regarding the meds that they are going to be placed on usually lasting anywhere from 30-60minutes. I have been having them bill a 98960, for 60mins 98960x2. The questions and some of the patterns I have been running into lately are that they are writing a note, HPI/Exam, MDM and billing for example a 99213 and then a 98960. No where in the note does it explain the amount of time spent with the patient, so I have been just billing the 99213.

I have 3 suggestions for them...

1- If patient is here for a sick call and chemo teach, bill the level for sick call with the sick dx and then bill the chemo teach with the cancer dx, example 99213 with dx 787.01 and 98960 with dx 162.9.

2- If the paient is in for chemo teach just bill the 98960 but make sure the note has the exact minutes to verify the teach code.

3- Write a note with HPI/Exam/MDM and include the exact minutes, everything discussed regarding meds and bill the highest level possible based on the note and to not bill the chemo teach at all.

I am not sure what the best way to go about this is... does anyone have any suggestions???

Thanks,
Tracy

Are these drugs given thru a pump?

that code is for self-management teaching. You can use the prolonged services codes 99354 added to 99215 for 40 min plus 30 min.

chemo teach

Not all of them are for pump drugs, could be something as simple as b12/aranesp shots to pump drugs and other IV drugs.

Would you suggest doing prolonged services for all of them? I know that you need atleast a 75mins of time for a 99215, 99354, so if they did the note and dictated all the time they spent face-to-face, then this would be billable, I know, but we do so many of them that I am wondering if the "all of a sudden" billing of the prolonged codes would set up red flags?

If you did it, bill it!

If you get audited and can show a schedule with one patient every 60 minutes and the documentation and diagnosis fits then you will be ok. If your doc's schedule for the day has 30 patients, they will know it is physically impossible to see a lot of 75 minute patients.
The best documentation would include actual time "pt visit from 9:15 to 10:30 AM"