The below addresses your question regarding an E/M code being reported.
"If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appropriate E/M serivce (99201-99215, 99241-99245, 99354-99355) should be reported using modifier 25 in addition to 96360-96549. For same day E/M service, a different diagnosis is not required?. The above listed E/M service codes represent office or other outpatient services."
"from a CPT coding perspective and as stated in the Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration guides, in the facility setting, the physician would not report 96360-96379, 96401-96402, 96409-96425, nor 96521-96523. In a typical emergency department setting, the physician should report the appropriate level emergency department E/M service code (99281-99285) or the appropriate observation codes (99217-99220, 99224-99226). Physician supervision of staff is expected to occur uniformly in the emergency department and/or if the emergency department physician is overseeing the management of an observation status patient. The facility reports the appropriate infusion code(s) administered by the facility staff based on the hierarchy outlined in the CPT guidelines.
In the outpatient office setting, the physician may report the services/procedures described by codes 96360-96379 and 96401-96549 whether performed by the physician per se or administered by his/her office-based trained staff. In most cases in the outpatient office setting, the physician directly supervising the staff is responsible for the practice expense component of the service. This is not typically the case in the emergency department or observation setting of the facility. In addition to codes 96360-96379, 96401-96549, the appropriate level office or other outpatient Evaluation and Management Service code with the modifier 25 appended may also be reported provided a significant separately identifiable E/M service is performed for the same day as the infusion(s).
In summary, these codes predominantly address the Resource Based Relative Value System (RBRVS) practice expense of infusions. As noted in the introductory language, "Physician work related to hydration, injection and infusion services predominantly involves affirmation of treatment plan and direct supervision of staff. Codes 96360-96379, 96401, 96402, 96409-96425, 96521-96523 are not intended to be reported by the physician in the facility setting. If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appropriate E/M serivce (99201-99215, 99241-99245, 99354-99355) should be reported using modifier 25 in addition to 96360-96549. For same day E/M service, a different diagnosis is not required?. The above listed E/M service codes represent office or other outpatient services. Not listed are the emergency department service codes 99281-99285, nor the observation codes 99217-99220, 99224-99226, 99234-99236.
The Centers for Medicare and Medicaid Services has designated these services as "incident to" codes for physician reporting. This indicator identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by carriers for these services when they are provided to patients in a hospital outpatient department. Modifiers 26, Professional Component and the HCPCS Level II -TC [technical component] cannot be used with these codes for reporting under the Medicare program.
It is also recommended that individuals check with their local carriers and commercial payers in order to properly determine the payment policy related to these services"
