99211 for chemo teach

[LuckyLily]

Can a chemo teach be charged anything higher than a 99211? (A NP does these.) A lot of our chemo teaches are 40-60 minutes and I am wondering if they can be billed by time. If they can only be billed a 99211 where can I find that concrete information that way I can bring it to my coworkers. Any info would help.

Thanks in advance

 

[OCD_coder]

I have had auditor's state that Chemo Teaching is inclusive to the chemotherapy administration codes whether performed on the same or different day than the infusions. But I have never had anyone (carrier, auditor or Medicare rep) backup that information up with any authoritative source.

Theory:
There is no E&M service inclusive to chemo or therapeutic administration codes as the NCCI manual clearly states that it only applies to minor procedures. The global status code for the administration codes is an XXX; meaning it's not a "minor" procedure and they do not have an E&M service included in the service.

What does this mean for you? If the nurse practitioner documents their time correctly meaning, it meets all the criteria set by the CPT; they should be billing the E&M that appropriately describes the level. A 99211 is under-coding, probably.

We have been billing our NP's for years and have never had any carrier tell us differently when we specifically ask on this issue. I agree most visits are typically 99214 and possibly 99215's based on their typical time of 45-60 minutes. If chemo-administration is performed on the same DOS, a 99211 cannot be billed regardless of how well it's documented. This allows for the proper E&M to be billed.

 

[Kiana]

Chemo Coder

"Can a chemo teach be charged anything higher than a 99211? (A NP does these.)"

I agree with OCD_Coder, "There is no E&M service inclusive to chemo or therapeutic administration codes as the NCCI manual clearly states that it only applies to minor procedures. The global status code for the administration codes is an XXX; meaning it's not a "minor" procedure and they do not have an E&M service included in the service. We have been billing our NP's for years and have never had any carrier tell us differently when we specifically ask on this issue. I agree most visits are typically 99214 and possibly 99215's based on their typical time of 45-60 minutes. If chemo-administration is performed on the same DOS, a 99211 cannot be billed regardless of how well it's documented. This allows for the proper E&M to be billed."

If chemo teach is what the patient is coming in for, yes, most of the time the NP does these, they can chart a 99211 which states, "Office or other outpatient visit for the E&M of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these. Although we know that chemo teaching does run more than 5 minutes, because the physician is not providing a history, exam and and MDM, 99212 through 99215 would require meeting 2 of 3 key components which a nurse practitioner is not doing, therefore, this is the only code you can use with a V65.49 "other specified counseling as your primary dx.