Revenue Cycle Insider

Question: Are there guidelines out there for when you would and would not bill an evaluation and management (E/M) service on the same day as chemotherapy? We have providers who will see the patient periodically before chemo to review their status. I know that if there is a new problem the provider addresses or a change in medication, and if documentation supports, that would support the E/M. What about just reviewing the medication given for that visit?

AAPC Forum Participant

Answer: If the provider is simply clearing the patient for treatment that day, the visit is not separately identifiable and is not billable.

However, if the provider's documentation shows that the purpose of the visit is to assess the cancer and status of disease because the patient has new or worsening symptoms; if there are new pathology, test, or scan results that the provider needs to address with the patient; or if the purpose of the visit is to address other conditions the provider is managing, then you have a good case for billing the E/M.

Simply put, when you look at the record, take out anything related to the treatment or clearance for treatment from the assessment and plan and, if you still have enough to support a visit, that’s what you’ll use to determine the E/M level.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC