Colliemom
Expert
Good morning,
We have patients that come in for Remicade infusions. Prior to having the infusions, the physician meets with the patient and wants to bill a 99212/99213. I am getting conflicting answers from different sources, and I wanted to see if some of you could weigh in as well. We are having a meeting with the providers to make a decision on how to handle this today, so we are trying to get the best and most accurate answer possible.
From one source we were told the following:
Remicaid Infusions
• Just because the physician went into the infusion room doesn’t mean you can bill an office visit. To bill an office visit there would have to be a chief complaint or issue that occurred. There needs to be some other indication besides the infusion.
We were told that providers should only be billing for the office visit with the infusion if there is a problem/dx separate from the reason for the infusion. But the providers strongly feel it is necessary to perform an Evaluation & management visit prior to starting the infusion to make sure the patient is feeling well, has not had any issues since the last infusion, and is generally healthy enough to undergo the infusion. They feel that these visits are important because even brief encounters may yield significant interval histories that can change management and are important for the safety of the patient. Without the -25 modifier, the insurance carriers are bundling the visits, do you think the visits warrant use of the -25 modifier, which indicates a significant, separately identifiable e/m service when the providers are using the same dx for the e/m visit and the infusions?
The visits are all follow-up visits without new complaints, seen in the infusion suite. The providers think that adding a -25 modifier to the e/m visits would be warranted, but there is no documentation of a significant/separately identifiable E/M service. (the visit is for the same dx as the infusion)
1) Do you think the visits are billable? (They are documented in a separate note from the infusion.)
2) Would the patients have to be evaluated for a different problem/dx, if the visit is billed on the same day as the infusion and the provider used the -25 modifier? The insurance companies are bundling the visits unless the -25 modifier is added.
Thank you so much! We really appreciate your assistance in trying to determine the best way to proceed.
We have patients that come in for Remicade infusions. Prior to having the infusions, the physician meets with the patient and wants to bill a 99212/99213. I am getting conflicting answers from different sources, and I wanted to see if some of you could weigh in as well. We are having a meeting with the providers to make a decision on how to handle this today, so we are trying to get the best and most accurate answer possible.
From one source we were told the following:
Remicaid Infusions
• Just because the physician went into the infusion room doesn’t mean you can bill an office visit. To bill an office visit there would have to be a chief complaint or issue that occurred. There needs to be some other indication besides the infusion.
We were told that providers should only be billing for the office visit with the infusion if there is a problem/dx separate from the reason for the infusion. But the providers strongly feel it is necessary to perform an Evaluation & management visit prior to starting the infusion to make sure the patient is feeling well, has not had any issues since the last infusion, and is generally healthy enough to undergo the infusion. They feel that these visits are important because even brief encounters may yield significant interval histories that can change management and are important for the safety of the patient. Without the -25 modifier, the insurance carriers are bundling the visits, do you think the visits warrant use of the -25 modifier, which indicates a significant, separately identifiable e/m service when the providers are using the same dx for the e/m visit and the infusions?
The visits are all follow-up visits without new complaints, seen in the infusion suite. The providers think that adding a -25 modifier to the e/m visits would be warranted, but there is no documentation of a significant/separately identifiable E/M service. (the visit is for the same dx as the infusion)
1) Do you think the visits are billable? (They are documented in a separate note from the infusion.)
2) Would the patients have to be evaluated for a different problem/dx, if the visit is billed on the same day as the infusion and the provider used the -25 modifier? The insurance companies are bundling the visits unless the -25 modifier is added.
Thank you so much! We really appreciate your assistance in trying to determine the best way to proceed.