klursky
Contributor
Does anyone know when chemotherapy is held/cancelled due to labs being higher than the parameter, can you bill for E/M with modifier 25 with the labs? Labs are always performed prior to infusions/injections and a nurse has to review the lab results prior to chemo, but if labs are not satisfactory, infusions/injections are cancelled. Would it be appropriate to bill for an E/M level w/mod 25 with the lab charges all on the same day? I am unable to locate any CMS guidelines for this particular scenario. Any help is greatly appreciated. TIA!
Documentation: male presenting for weekly epoetin alfa-epbx (Retacrit) SQ injection. No Retacrit was given due to Hct is higher than parameter.
Pt was ambulatory.
Hgb=10.4, Hct=33.4 today. No Retacrit was given. Last Retarrit was given on 7/13/23. Pt did not need Retacrit last 3 weeks. The PA, was notified at 4 pm. The PA said pt can do every 2 weeks. Schedule was updated to Retacrit every 2 weeks.
Patient Education Received/ Reinforced: Yes
Was Physician notified for any reason:Yes
If Yes, list any outcomes from the conversation (dose modification, additional orders): See notes above.
PATIENT EDUCATION
*Follow-up teaching session was provided for patient XXX on 8/10/2023. Patient readiness to learn is high.
Participants present: patient.
Participants present: patient.
*Barriers to learning: no barriers to learning identified.
*Teaching methods used: verbal instruction.
*Discussion topics: DISEASE AND TREATMENT: laboratory values, medication/adverse effects and treatment plan, SYMPTOM MANAGEMENT: fatigue and SELF CARE: what to report to MD/RN.
*Education resources given: Chemotherapy calendar.
*Patient response to education:verbalized understanding.
*Time spent :11-20 minutes