Oncology/Hematologyy

Need official guidelines for chemotherapy teaching for patients by NPP. Everything
I can find states it is inappropriate to bill separately for this service.
Also, is disconnection of chemo pump a billable service when it is the only service
provided on a given date of service? Thanks for any responses, Paula

Chemotherapy Teaching

According to ASCO's frequent answers and questions on Drug Administration codes, "Physician time spent on treatment planning and management is considered to be captured under the E&M codes. Chemotherapy management cannot be billed separately. Time spent by nursing staff and other health professionals on nutrition counseling, therapy management and care coordination is also not separately billable."

Whenever a pump infusion is completed, the patient usually returns to have the pump disconnected. Some insurers indicate that pump disconnect is part of 96416, while others will allow this service to be reported with a low-level established patient visit code (e.g., 99211).

Hope this helps.

Pat

Oncology/hemoc

that's what I had researched too. thanks so much for your reply. Paula

Need Help too!

Hello,

When you bill to the insurance companies other than Medicare do you add modifiers to the refill code and supply code? We are receiving denials for them being included in the procedure.

Chemotherapy teaching

Physicians time for treament planning and management is not separately billable as noted in the original message. The E&M codes level 1-5 do not even begin to reach the level of expertise for this service. Billing level 5 is the only way to capture a piece of the visit but the planning and management are time eaters.

Besides from billing them all level 5's (established patients currently undergoing chemo) does anyone have a grid or tool to use to differentiate level 4 from level 5 established chemo patients?

Thank You
Louise

pump disconnect

Pat,
You responded a month ago regarding my question about billing for a pump disconnect. The question is still not resolved inspite of my suggestions & your
very clear comment. Do you have any suggestions to guide me to something from
Medicare that can settle this in black & white? I feel to continue to bill a 96523 with heparin charge is not a safe billing practice. Please feel free to expound at length.
Signature Doc, if you are out there, I could use your expertise too. Thanks,
Paula