Forum - Questions & Answers
Chemo Infusion & E/M on same day on UB04
If a patient is seen in a hospital based outpatient Infusion Center for chemo and presents with dysuria and we treat the dysuria (confirmed UTI) and give the chemo, we would use an E/M w/-25 modifier, correct? Also, would the UTI dx code be added to the UB04 claim form also or just the dx code related to the chemo?
e/m and modifier 25 OPPS
Under OPPS if there is an E/M code and a procedure (ex, infusion), with a payment status indicator S or T on the claim and modifier -25 is not appended to the E/M code, OCE edit #21 will be triggered and the E/M code will not be reimbursed. S and T determine if a service is discounted or not. Yes, add the UTI diagnosis.
e/m icd
Thanks. What is an OCD edit #21. We add the -25 modifier but have not been adding the diagnosis to go with the E/M on the claim. So for example, all that is listed would be the V58.11, 162.9 and the chemo infusion codes and 99214-25 (for example)
Medicare edits outpatient
https://www.cms.gov/OutpatientCodeEdit/30_Background.asp#TopOfPage
oops
I meand OCE edit #21