Billing for chemotherapy/infusion regimen education

[mrosbun]

Hello,

Our APRN's are providing Chemotherapy/Infusion Regimen Education to the patients, generally the same day as treatment.

Is there a specific code for billing for Chemotherapy/Infusion Regimen Education, besides a time-based E/m or is this considered bundled into the the treatment? Also, does anyone have any (official) education material on this? I cannot find anything black and white.

Thank you in advance,

Ruby Osbun, CPC
Compliance Provider Auditor/Educator

 

[Pam Warren]

There is not. If there is sufficient documentation of a separately-identifiable E&M visit on the same day as the chemo administration, you can bill both. However, there is an element of patient education prior to chemo administration that is bundled into the code(s). Since the E&M is with regards to 'education' vs. treatment, you may have coverage issues.

From NCCI:

The drug and chemotherapy administration CPT codes 96360-96375 and 96401-96425 have been valued to include the work and practice expenses of CPT code 99211 (evaluation and management service, office or other outpatient visit, established patient, level I). Although CPT code 99211 is not reportable with chemotherapy and non-chemotherapy drug/substance administration HCPCS/CPT codes, other non-facility based evaluation and management CPT codes (e.g., 99201-99205, 99212-99215) are separately reportable with modifier 25 if the physician provides a significant and separately identifiable E&M service. Since physicians
[FONT=Courier New,Courier New][FONT=Courier New,Courier New]shall [/FONT][/FONT][FONT=Courier New,Courier New][FONT=Courier New,Courier New][/FONT][/FONT]not report drug administration services in a facility setting, a facility based evaluation and management CPT code (e.g., 99281-99285) [FONT=Courier New,Courier New][FONT=Courier New,Courier New]shall [/FONT][/FONT][FONT=Courier New,Courier New][FONT=Courier New,Courier New][/FONT][/FONT]not be reported by a physician with a drug administration CPT code unless the drug administration service is performed at a separate patient encounter in a non-facility setting on the same date of service. In such situations, the evaluation and management code should be reported with modifier 25. For purposes of this paragraph, the term "physician" refers to M.D.’s, D.O.’s, and other practitioners who bill Medicare claims processing contractors for services payable on the "Medicare Physician Fee Schedule".