Oncology & Hematology Coding Alert

Here's why 99211 flashes a bright red 'audit me' sign at payers. At roughly $60 a pop, missing just one 99213 service a day could cost your practice more than $15,000 a year. Use these official rules from Medicare to be sure you know when you should -- and shouldn't -- add an E/M code to your therapeutic drug and chemotherapy administration claims. Nip 99211-Based Denials in the Bud Medicare will not pay 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) separately when you report it alongside the following: • Chemotherapy or nonchemotherapy drug administration • Diagnostic or therapeutic drug injection. The Medicare Claims Processing Manual (MCPM), Chapter 12, Section 30.6.7.D spells this rule out for you (www.cms.hhs.gov/Manuals/IOM/list.asp). The [...]