Oncology & Hematology Coding Alert

Question: I have heard that I should charge every infusion patient for a patient visit on the same day. Is that correct??

Massachusetts Subscriber

Answer: Payers do not require you to bill an office visit with infusion treatments for an established patient, but you can bill for both when appropriate.

If a patient presents only for chemotherapy without an E/M, for example, report the correct administration codes and, if you bear the drugs- cost, the associated drug codes.

But if the oncologist provides an E/M service separate from the chemotherapy, such as evaluating a patient's nausea complaint, report the infusion, the drugs if appropriate, and an E/M code.

Tip: You should report an E/M code only if you have the documentation supporting that the oncologist provided a separates service.

If you do bill for both, append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit.

-- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.