Wiki Use of E&M code with chemotherapy tx

[Barbara Knox]

Can I get some help with this question?

My providers are upset that they are being told that they cannot charge an E&M with chemotherapy tx when it is a subsuquent visit only if addressing a new issue...what about because it is symptom management of their ongoing chemotherapy? Any and all help appreciated

 

[davidsnk]

If the physician is just seeing the patient to determine if he/she is cleared for treatment that day, then no, you cannot bill an E&M.

However, if the physician is seeing the patient for anything that is significantly separately identifiable, then yes, they can bill with a 25 modifier.

If the physician is reviewing all meds, tests, labs, going over side effects from chemotherapy, etc., that would be a valid reason to bill as long as the documentation supports that.