Chemotherapy and office visits

Good morning. I have been seeing many claims where the patient was seen for "here for chemotherapy protocol....." The patient is having no problems, doing well, etc. A history, exam and mdm is documented and they continue on to receive their infusions.

My question is this. Would it be appropriate to bill for an office visit in addition to the chemotherapy in these situations? Many of the providers are wanting to, but I just don't know that it would be appropriate. In addition, there are times the patient comes into receive their chemotherapy and then are admitted to the hospital as inpatient. How does that work?

Any help would be greatly appreciated. Thank you so much!

Michelle Yaden, CPC

chemo

Medicare recognizes the need for chemotherapy-related visits in which the physician is present. And, most cancer treatments follow protocols that elaborate on how often a patient should be seen during treatment, as well as the normal course of treatment.

Any hospital admission must be medically necessary.

Chemotherapy and office visits

So, if the protocol is that the patient comes in every week for chemo and the physician sees them and documents the visit, then an E/M is billable? Am I understanding that correctly?

As far as the inpatient admit, they are being admitted for chemo, but they go ahead and administer chemo prior to the admit. So, I have chemotherapy billing and then an initial hospital visit also being reported.

chemo/office visit

Are you a physician's office or outpatient hospital based clinic?

chemo/office visit

We have both, actually.