Question Ambulatory Infusion Center E/M billing


wilmington, IL
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I have questions about the proper billing for an ambulatory infusion center at our hospital.

The infusion center wants to bill an e/m code for every visit. They usually use 99212. There is no physician on site, only RNs. The manager feels that since the e/m codes are time based that they can justify using the e/m codes with the infusion charge. I have informed her that the e/m code cannot be billed with the infusion unless there is a significant/identifiable situation that happens. She feels that when they have long infusions, i.e., IVIG, that they can use the e/m code for the extra vitals & assessments they have to do. I also told her that the 99211 can be used when the patient comes in and only sees the nurse. For example, when they come in for just a dressing change on their port or have their PICC line removed.

1. Can someone confirm that they cannot use the e/m codes for the extra vitals/assessments? Everything I have found, says they cannot.
2. Does anyone have a link/article they can share that would provide a time it would be appropriate for them to use an e/m code?

Thank you for your help!


Lithonia, GA
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Hi Julie
You are corrected in your thinking. Only Eva/Mgt codes are for treatments by MD, DO, NP ,PA .Some payers allow CNS (certified nurse specialist) to use Eval/mgnt codes. Per CMS and NCCI guidelines cannot use CPT 99211 when RN does infusions related to dx Z51.11 or Z51.12.
I hope this data helps you
Lady T:)