Reader Question: Oncology Patient

Question: I have several questions involving the visit of an oncology patient. Can we use 99211 for new patients and can it be used when the physician does not supervise the visit? Also, can we append modifier -25 to this code or will 99211 trigger the need for modifier -27 if the patient also has an ED visit within the same 24 hours? Do I have to use a V code for my primary diagnosis or do I use the cancer first and the V code second?

Alaska Subscriber

Answer: Code 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) was created specifically for established patients (one who was seen by your system within the past three years) in an office or outpatient clinic. You can use the code when a physicians presence is not required.

If a procedure is performed in addition to the E/M service, you could append modifier -25 (significant, separately identifiable evaluation and management service by the same physician during a postoperative period) to the E/M code. However, your documentation must reflect that a service beyond the procedure was performed. You would use modifier -27 (multiple outpatient hospital E/M encounters on the same date) if you were reporting several E/M codes on that same day.

V codes describe circumstances that influence a patients health and identify reasons for medical encounters resulting from circumstances other than a disease or injury as classified in the main part of ICD-9. In your case, the rationale provided in ICD-9 2001 would be b) When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change). Use the cancer first and the V code second.

- Published on 2001-05-01