bgeiser
Contributor
Although I been a coder for many years, I have never coded hematology so my knowledge of it is limited.
I recently needed some treatment at a hematology/oncology practice for iron deficiency. I had three Venofer infusions that I believe were coded and billed incorrectly to my insurance and am interested in your input.
My initial visit was with a NP; I did not see the physician. This 99243 visit was billed under the group with the rendering provider as the physician, not the nurse practitioner.
My three subsequent visits were for infusion only and went like this...
The nurse comes into the waiting room, calls my name and as we walk back to the treatment room, there is small talk. I tell the nurse that I hope the iron helps with the severe fatigue I've been feeling. I sit in the chair, she gets the iron, connects it to me via a butterfly in the hand, I put in my earphones & enjoy music for the next hour. When the infusion finishes, she removes the needle, puts a bandaid on me and I'm on my way.
They were billed with: 99211, 36415, 96365, 96365 -SU -59, J1756 (300 units).
I don't understand the 99211 because everything I've read and every workshop I've attended states no 99211 with infusion, nor do I understand 36415 if there was not a blood collection. My understanding of why the second 96365 with modifiers SU and 59 was billed - a facility fee. The "facility" is a part of the same building; it is a large room filled with recliner chairs, IV pumps, etc where all infusions and chemotherapy treatments are done.
I discussed this with the office and they said 36415 is always used and that the nursing visit (99211) is valid because she asks how I am feeling.
Know I appreciate your time in reading this and responding to it.
I recently needed some treatment at a hematology/oncology practice for iron deficiency. I had three Venofer infusions that I believe were coded and billed incorrectly to my insurance and am interested in your input.
My initial visit was with a NP; I did not see the physician. This 99243 visit was billed under the group with the rendering provider as the physician, not the nurse practitioner.
My three subsequent visits were for infusion only and went like this...
The nurse comes into the waiting room, calls my name and as we walk back to the treatment room, there is small talk. I tell the nurse that I hope the iron helps with the severe fatigue I've been feeling. I sit in the chair, she gets the iron, connects it to me via a butterfly in the hand, I put in my earphones & enjoy music for the next hour. When the infusion finishes, she removes the needle, puts a bandaid on me and I'm on my way.
They were billed with: 99211, 36415, 96365, 96365 -SU -59, J1756 (300 units).
I don't understand the 99211 because everything I've read and every workshop I've attended states no 99211 with infusion, nor do I understand 36415 if there was not a blood collection. My understanding of why the second 96365 with modifiers SU and 59 was billed - a facility fee. The "facility" is a part of the same building; it is a large room filled with recliner chairs, IV pumps, etc where all infusions and chemotherapy treatments are done.
I discussed this with the office and they said 36415 is always used and that the nursing visit (99211) is valid because she asks how I am feeling.
Know I appreciate your time in reading this and responding to it.