Oncology & Hematology Coding Alert

Question: If the radiation oncologist performs a new patient E/M on a patient, is it OK to code another E/M when the patient returns months later for treatment?


Iowa Subscriber

Answer: You may report another E/M, as long as your documentation supports medical necessity. If the oncologist does perform another E/M service, you should choose the appropriate code from established patient codes 99211-99215.

Example: A patient returns three months after his initial visit to begin treatment. The radiation oncologist performs a level-four E/M to determine if the tumor volume or extent of the disease has changed. Report established patient code 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: a detailed history; a detailed examination; medical decision-making of moderate complexity ...).