Wiki Admit for Chemo

[karey]

if a patient goes to the hospital for chemo treatment and is there overnight, what E/M would you use? It is an Outpatient procedure so would you use 99211-99215 or would you code as an observation? She wasn't even in the hospital for 24 hours.

 

[ivd34769]

We have used 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s). Usually, the problem(s) requiring admission to "observation status". Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit. The descriptor will add “qualified health care professionals.” It is now clarified that all E/M codes can be reported by physicians or other qualified health care providers and AMA changed the wording with regard to time in each of the E/M codes — which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes. If a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify. This language change clarifies things in two ways. First, the “E/M service changes indicate nonphysician providers (NPPs), especially PAs and NPs, can provide E/M services on their own, can bill on time alone, and can do counseling and coordination of care on their own. Second, it clarifies that “you have to have that counseling with someone who is certified or technically licensed to provide that type of service; hope this helps