Wiki Billing E&M and Chemo Treatment

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slmpayroll

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HELP, New to Oncology. I know you cannot code an E&M visit on the same day as an infusion treatment. So we were looking at having the patient come in the day before for their labs and visit. I keep getting told by my compliance department that we still cannot bill the E&M visit the day before the infusion treatment that there needs to be at least a 3 day lag time.

Can someone help me with this, can I bill an E&M visit the day before an Infusion treatment?

Thanks

Shannon
 
Chemo and E&M

Append the modifier 25 to the E&M code.
IF there is an ICD 9 code that fits the E&M code as the reason for the visit use it. If physician is changing med or patient is having a reaction to meds such as nausa, anemia, tingling, numbness or dizziness and the doctor addresses the issue then same day E&M's are paid normally.
 
An E&M can be billed on the same day as chemotherapy with a 25 modifier if it is indeed a separate identifiable service with clear documentation....
 
This is a hotly debated topic, whether to allow for an E&M on the same day as infusions performed. A patient being given chemotherapy must be monitored very closely for side effects of the chemotherapy drugs. This is no different than monitoring a patient with a chronic condition such as MS or rheumatoid arthritis or a diabetic which require routine labs also, just not as frequently. There is a lot of work our oncologists must perform to manage a cancer patient, infusions are only one part.

I educate my providers to concentrate on documenting side-effects (signs or symptoms, abnormal lab work) of the chemotherapy when they occur to support a separate, significant E&M. Many auditors look at infusions as surgical procedures, they are not. Here is a blurp from Palmetto MAC supporting that thought. Granted, a new patient will probably not get chemo on their firt visit. But modifier 25 would still be necessary on established CPT codes. Focus on the important part of this information, infusions are not to be considered surgical procedures.

New patient CPT codes require CPT modifier 25 when a separately identifiable E/M service is performed the same day as chemotherapy or nonchemotherapy infusions or injections as these are not considered surgery. For example, CPT codes 96401 and 96372.
 
I code for a free-standing Oncology Infusion Center and I have educated the Oncologists about E/M visits with infusion the same day. we only code/bill for E/M visits where the patient is having symptoms, change in chemo administration. If the provider see the patient and everything is stable with no symptoms, no change in meds, labs stable, it would be part of the infusion visit for that day and would not be spearately billable. From a billing standpoint, I have not received any denials when E/Ms are documented this way. There must be medical necessity for the billing that visit separate from the infusion visit. Hope that helps.

Annette W., CPC, CEMC
 
E&M in infusion coding

Where can I learn the E&M rules for infusion coding? I have the procedure codes down, but we only code the procedures here and the CHONC exam will cover both E&M and Procedures.

Anyone??

Thanks!

Flycliffyboo
 
CMS Claims Processing Manual 100-04
Chapter 12 - Physicians/Nonphysician Practitioners
30 - Correct Coding Policy
30.5.F
Chemotherapy Administration (or Nonchemotherapy Injection and Infusion) and Evaluation and Management Services Furnished on the Same Day
For services furnished on or after January 1, 2004, do not allow payment for CPT code 99211, with or without modifier 25, if it is billed with a nonchemotherapy drug infusion code or a chemotherapy administration code. Apply this policy to code 99211 when it is billed with a diagnostic or therapeutic injection code on or after January 1, 2005.
Physicians providing a chemotherapy administration service or a nonchemotherapy drug infusion service and evaluation and management services, other than CPT code 99211, on the same day must bill in accordance with ?30.6.6 using modifier 25. The carriers pay for evaluation and management services provided on the same day as the chemotherapy administration services or a nonchemotherapy injection or infusion service if the evaluation and management service meets the requirements of section ?30.6.6 even though the underlying codes do not have global periods. If a chemotherapy service and a significant separately identifiable evaluation and management service are provided on the same day, a different diagnosis is not required.In 2005, the Medicare physician fee schedule status database indicators for therapeutic and diagnostic injections were changed from T to A. Thus, beginning in 2005, the policy on evaluation and management services, other than 99211, that is applicable to a chemotherapy or a nonchemotherapy injection or infusion service applies equally to these codes.
 
Billing E/M with Chemo treatment

slmpayroll said:
HELP, New to Oncology. I know you cannot code an E&M visit on the same day as an infusion treatment. So we were looking at having the patient come in the day before for their labs and visit. I keep getting told by my compliance department that we still cannot bill the E&M visit the day before the infusion treatment that there needs to be at least a 3 day lag time.

Can someone help me with this, can I bill an E&M visit the day before an Infusion treatment?

Thanks

Shannon
Click to expand...

Hi Shannon,

You can certainly capture and bill both services. Keep in mind the documentation for the E/M should stand alone; therefore, it should really address another reason beyond the fact the patient is there to receive their chemo treatment. Ensure you append a 25 modifier to the E/M to alert the payor the service is separately identifiable from the chemo treatment.

Thanks,
Ashley Miller, CPC, CHONC, CPPM
Oncology Consultant
Revenue Cycle, Inc.
 
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