Forum - Questions & Answers
E&M with Chemotherapy codes
I'm new to chemotherapy coding/billing. Actually, reviewing some old claims.
Appears there are times our MD's bill for an E&M (99212 & 99213), as well as the actual chemo codes.
Theses E&M codes are modified with -25, which then bypass CCI edits.
Upon review of documentation, their E&M levels are accurate but I do find the E&M is related only to the assessment of the patient and plan that relates to the chemotherapy.
I am under the impression that in order to bill an E&M along with chemo codes, the E&M must stand on its own, independent, separate and unrelated of any chemotherapy given that day.
I would greatly appreciate any clarification of this coding.
Deb P
re: E&M with Chemotherapy codes
http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/EM%20coding%20with%20Drug%20Infusion%20Services%203-10-10.pdf.
Medicare will consider payment for E/M services other than 99211 provided on the same day as the chemotherapy administration services or a non-chemotherapy injection or infusion service if the E/M service meets the requirements of the CMS Internet-Only Manual, Pub. 100-04, Chapter 12, Section 30.6.6, even though the underlying codes do not have global periods. The IOM publication can be
accessed at:
http://www.cms.gov/manuals/downloads/clm104c12.pdf
If a chemotherapy service and a significant separately identifiable E/M service are provided on the same day, a different diagnosis is not required.