Chemotherapy Infusion and E/M on the same day

July 3rd, 2009 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)   Modifiers   Specialty Coding  
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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.

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