Oncology & Hematology Coding Alert

Question: How should I bill for administering oxygen in the office setting? We had a patient who had an adverse reaction to a drug. The physician saw the patient and charged for an office visit. Oxygen was administered, and the nursing staff observed the patient for about an hour.
                
Virginia Subscriber  
Answer: There is no code that reports the administration of oxygen to a patient. Instead, this administration would contribute to the level of medical decision-making for the E/M service (99201-99215).
 
Medical decision-making refers to the complexity of establishing a diagnosis or selecting treatment options, or both. CPT instructs physicians to use three areas to help determine the complexity of medical decision-making:

  The number of possible diagnoses and/or the number of management options that must be considered

  The amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed and analyzed

  The risk of significant complications, morbidity, and/or mortality, as well as comorbidities associated with the patients presenting problem, the diagnostic procedures and/or the possible management options.  
To characterize medical decision-making as highly complex, physicians need to prove two of the following: extensive number of diagnoses or management options; extensive review of data; and high risk of complications, morbidity or mortality.
 
To prove moderate complexity, physicians must show two of the following: multiple diagnoses or treatment options, moderate review of data, and moderate risk of complications.
 
The final determination of the level of the visit also depends on the level of the two remaining components of an E/M visit history and exam. Because the reader does not provide any detail to either of these components, it is difficult to choose an accurate E/M code.
 
However, because the physician had to address an adverse reaction to a drug, the level of medical decision-making may qualify as moderately complex based on the risk of complications.