# E/M Level or No E/M Level with Procedures



## bhamfred (Sep 5, 2013)

Hi there, I am studying for my CPMA exam on 9/14 and I'm having a mental block.  There are a couple scenarios in the online study guide that have caused me to have some confusion.  
One PT comes in for a Synvisc injection for chronic knee pain.  This would be her third injection.  She reports minimal improvement between the #1 and #2 injections.  I understand that this is a visit for the injection only and no E/M is assigned.  Another scenario involves chemotherapy and this one got a level 3 as well as all the chemo related codes.  I don't understand what the difference between the two is.  
Is there a rule of thumb I can go by to determine whether to assign a level or just the procedure?  
For the last 3 years I've only been coding/auditing ED charts - every chart gets an E/M level.  

Thank you for your time,

Michelle Brown, CPC


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## AB87 (Sep 10, 2013)

The first scenario is right because it was for the Routine Injections. The 2nd is totally wrong,here are the Rules for the E/M and Chemo Therapy Injections

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R731CP.pdf


4032.3
*Effective January 1, 2004*, contractors shall not pay for CPT code 99211 when reported with or without CPT modifier -25, with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code. Effective January 1, 2005, contractors shall not pay for CPT code 99211 when reported with or without CPT modifier -25, with a therapeutic or diagnostic injection code.


Not only that a Big Hem/Onc group in Georgia was taken to court over this same guideline, They were billing E/M Codes along with Chemo Injections which there wasn't another reason for the Visit other than the Cancer. The CPMA study guide needs to be revised ASAP.


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## bhamfred (Sep 11, 2013)

Thank you for clarifying.  I thought I was losing my mind!


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## GretaGrbo (Jun 18, 2020)

I have a E/M question for the year 2019.  Established Outpatient Clinic patient comes in and the results are a Detailed History, Comprehensive Exam, and a Low MDM.  The E/M guidelines say that you have to have 2/3 elements in order to code the level.  My interpretation of this is that you have to use the code the element furthest to the left and the next highest element.  I have a clinic interpreting it just the opposite, you just have to have any 2/3 elements for an established patient.  I have a E/M worksheet that I found online and it says "2/3 elements must be at the SAME level or higher to bill at that level".    Does anyone have clearer guidelines that I could review?  Thank you, Denise Rising, CCS, CRC


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## SharonCollachi (Jun 18, 2020)

GretaGrbo said:


> I have a E/M question for the year 2019.  Established Outpatient Clinic patient comes in and the results are a Detailed History, Comprehensive Exam, and a Low MDM.  The E/M guidelines say that you have to have 2/3 elements in order to code the level.  My interpretation of this is that you have to use the code the element furthest to the left and the next highest element.  I have a clinic interpreting it just the opposite, you just have to have any 2/3 elements for an established patient.  I have a E/M worksheet that I found online and it says "2/3 elements must be at the SAME level or higher to bill at that level".    Does anyone have clearer guidelines that I could review?  Thank you, Denise Rising, CCS, CRC



I would suggest you start a new thread as this is not related to the one you posted on.  It will get more responses that way.


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