Wiki Adverse reaction to Chemo Infusion

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staceylh

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What should we bill in the case of an infusion being stopped due to the patient having an adverse reaction? My initial feeling is that if the time frame for billing the first hour has elapsed that we can charge that hour, but what if treatment stops after only 10 minutes? Do we then charge and E/M level for the visit; would the patient need to be evaluated by and MD, or could we charge for nursing?
 
allergica reaction

Are you charging in a facility or dr office? I can speak to what we do in the facility.

If the patient has a reaction and the treatment is stopped and the RN has to call the dr to get an order to give benadryl, etc. we charge a facility E/M for hospital resource. The E/M can be charged because the RN detoured from the original reason why the patient was being seen.

Example:

Rituxan 9:00 - 9:10 stopped due to reaction
RN calls dr to get order of benadyrl
RN gives benadryl
Rituxan restarted at 9:20 - 10:00 (we would add the times together so the patient got Rituxan for a total of 50 minutes 96413) and amend the E/M with a -25 modifier for the appropriate level based on our acuity sheet.
 
I bill for a physician office and we would do the same.

You can bill for what is done (no more, no less). If the infusion is stopped after 10 minutes and not restarted, bill the push code (96409). If the infusion is restarted, bill for the total time of administration.

Don't forget to bill for the Benadryl time too. ;)
 
Services would be provided at a local cancer treatment center in future but are now provided within the hospital. Per one of our IVT nurses, I'm told that they charge for the infusion based on time elapsed and then if necessary, any labs or other injections that may be given. They currently do not charge and E/M; in fact; she didn't even know what that meant. They charge only for the services/procedures provided. Who makes the determination on which level of E/M you're billing? Services for infusion therapy are currently hard-coded from IVT. Thanks!
 
We use an acuity sheet to determine the level of the E/M in our facility based clinic since there are not separate E/M codes developed for facilities. You need a policy to determine how you will charge/determine your E/M. Also, you can't charge a 99211 with chemo also. I had to develop one for our outpatient hospital facility per the Federal Register guidelines.

What is IVT?
 
Thank you for your response. One of our IV Therapy managers in the hospital had been questioned as to what charges they enter in these situations. They've had no education regarding E/M.
 
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