clopez
Networker
Hello,
I'm new to Oncology and during the E/M audit I have come across encounters billed for Chemotherapy teaching by the NP with 99212. I've researched and found contradicting information where some say its okay to bill for it while others say it's not. I did come across a MCR transmittal from 10-02 That gives this scenario: Based on this can I advise the NPs to bill the Chemo teaching based on time instead of billing all Chemo teachings under same level 99212 Ive also come across where in forums they recommend billing it as 99211... Or if anyone can provide me with updated guidelines set by CMS I greatly appreciated.
C. Selection Of Level Of Evaluation and Management Service Based On Duration Of
Coordination Of Care and/or Counseling.--Advise physicians that when counseling and/or
coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter
or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting
the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3
criteria applicable to the type/level of service provided. However, the physician may document time
spent with the patient in conjunction with the medical decision-making involved and a description of
the coordination of care or counseling provided. Documentation must be in sufficient detail to
support the claim.
EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to
implement chemotherapy. At an office visit the physician discusses the treatment
options and subsequent lifestyle effects of treatment the patient may encounter or is
experiencing. The physician need not complete a history and physical examination in
order to select the level of service. The time spent in counseling/coordination of care
and medical decision-making will determine the level of service billed.
I'm new to Oncology and during the E/M audit I have come across encounters billed for Chemotherapy teaching by the NP with 99212. I've researched and found contradicting information where some say its okay to bill for it while others say it's not. I did come across a MCR transmittal from 10-02 That gives this scenario: Based on this can I advise the NPs to bill the Chemo teaching based on time instead of billing all Chemo teachings under same level 99212 Ive also come across where in forums they recommend billing it as 99211... Or if anyone can provide me with updated guidelines set by CMS I greatly appreciated.
C. Selection Of Level Of Evaluation and Management Service Based On Duration Of
Coordination Of Care and/or Counseling.--Advise physicians that when counseling and/or
coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter
or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting
the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3
criteria applicable to the type/level of service provided. However, the physician may document time
spent with the patient in conjunction with the medical decision-making involved and a description of
the coordination of care or counseling provided. Documentation must be in sufficient detail to
support the claim.
EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to
implement chemotherapy. At an office visit the physician discusses the treatment
options and subsequent lifestyle effects of treatment the patient may encounter or is
experiencing. The physician need not complete a history and physical examination in
order to select the level of service. The time spent in counseling/coordination of care
and medical decision-making will determine the level of service billed.