Revenue Cycle Insider

Question: I work for a rheumatology office. Sometimes patients come in for an infusion but see the doctor first. Should I be billing for the doctor’s time via an evaluation and management (E/M) service, even if the time is brief?

New Mexico Subscriber

Answer: Check the provider’s documentation to see whether it’s appropriate to bill an E/M service as well as the infusion administration separately.

Billing an E/M service may be appropriate when the provider’s services meet E/M level coding criteria via time or if they perform an exam, take patient history, evaluate a new problem or condition, change the treatment plan, or perform separate medical decision making (MDM), such as when a patient is showing symptoms of toxicity so the provider orders labs to monitor levels. The documentation would need to support medically necessary, significant and separately identifiable services from the infusion administration work.

In this situation, billing an E/M service for MDM or time with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended could make sense when those services are separately identifiable from the infusion administration that is performed on the same day. Again, the documentation would need to support both the E/M and the separately identifiable service.

However, if the patient sees the doctor more as a quick check-in before a scheduled infusion, to check on vitals, or other standard orders already part of the treatment plan, then documentation may not support a separately identifiable E/M beyond the infusion protocol.

As always, check with the patient’s respective payer to make sure you’re following their policies.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC