Many
oncology coders mistakenly believe E/M services and chemotherapy services are bundled but it's time for you to learn the truth and to receive proper reimbursement for both services.
Not only can you be reimbursed when the chemotherapy services are provided incident-to, but many LMRPs substantiate the practice of reporting E/M services with chemotherapy to get the reimbursement you deserve, and we'll show you how to do just that. Keep It Simple with Medicare Medicare recognizes the need for physicians continually to monitor and manage a patient's chemotherapy treatment, allowing them to be reimbursed for both E/M services and administration. The Medicare Carriers Manual states that "payment may be made for an evaluation and management service provided in conjunction with chemotherapy." You can bill for E/M services as long as the services are separately identifiable and are not related to the chemotherapy, says Dianne McQuarrie, CPC, insurance specialist, Central Georgia Hematology Oncology, in Macon, Ga. She explains that, often, a physician sees a patient to follow up on the status of his health, results of labs, outside consults, surgeries, or radiological services. On the same day, the patient will receive his intravenous chemotherapy treatment. In cases like this, you should code for the chemotherapy administration using 96408-96414. Don't forget to report the E/M services with codes from the series for established outpatient visit (99211-99215). Also, remember that 96412 is an add-on code and should be listed separately in addition to the code for the primary procedure. The "nurse-only visit" (99211) is the most common E/M service related to chemotherapy administration. If nurses provide nursing evaluations or direct patient care, if it is properly documented, you will report 99211. Be careful not to bill for this service when the nurse only administers the chemotherapy and does not do extra services, such as checking vitals or giving other injections. Code 99211 is often misused, so do not report it when patients come in to pick up supplies or drugs, because there is no examination taking place. Medicare does not require you to append modifier -25 (Significant, separately identifiable E/M service by the same physician ...) with the E/M service codes. Don't Shy Away from Higher-Level E/M Codes Remember that 99211 is not the only code available when coding for chemo-related E/M services. Higher levels of E/M codes should be considered if the patient sees a physician or other midlevel provider. McQuarrie says that the level reported depends on whether the patient sees the physician. Then, you should code for the level of service he provides, taking into consideration the key components of an E/M visit: history, exam and medical decision-making. As long as they meet the documentation requirements for 99212-99215, [...]
