I have been scouring the internet for resources to help me determine the guidelines for documentation and billing E&Ms on the same DOS as chemotherapy. I have read through 30.6.7 of Medicare Claims Processing Manual (Chapter 12) http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf :
D Drug Administration Services and E/M Visits Billed on Same Day of Service
Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.
And this document from ASCO:
http://www.asco.org/ASCOv2/Departme...oding with Drug Infusion Services 3-10-10.pdf
My understanding is that certain things are included with the RVUs for the infusion codes and they should not count towards the E&M. What is included? What constitutes a "separately identifiable office or other outpatient E/M service" in this situation?
What I have been doing when I review documentation is eliminating things that are necessary to be able to proceed with chemo when I 'grade' the E&M (review of blood counts to show patient is able to get chemo that DOS, review of orders, review of minor/expected side effects, etc). IS this an accurate list of what is included in the infusion codes? What all is included?
Should those things be eliminated in the calculation of the E&M level? Or can they be used for the E&M even though they are considered part of the infusion service?
I would really like to see more discussion on this topic. The instructions/documentation I have been able to find seem very vague. And I have a feeling that the E/M and its documentation is going to become a source of headaches for providers in the near future.
Alanna
D Drug Administration Services and E/M Visits Billed on Same Day of Service
Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.
And this document from ASCO:
http://www.asco.org/ASCOv2/Departme...oding with Drug Infusion Services 3-10-10.pdf
My understanding is that certain things are included with the RVUs for the infusion codes and they should not count towards the E&M. What is included? What constitutes a "separately identifiable office or other outpatient E/M service" in this situation?
What I have been doing when I review documentation is eliminating things that are necessary to be able to proceed with chemo when I 'grade' the E&M (review of blood counts to show patient is able to get chemo that DOS, review of orders, review of minor/expected side effects, etc). IS this an accurate list of what is included in the infusion codes? What all is included?
Should those things be eliminated in the calculation of the E&M level? Or can they be used for the E&M even though they are considered part of the infusion service?
I would really like to see more discussion on this topic. The instructions/documentation I have been able to find seem very vague. And I have a feeling that the E/M and its documentation is going to become a source of headaches for providers in the near future.
Alanna