Chemo teaching

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We were told that we can't bill for chemo teaching even if it is on a separate day from the actually chemo. For example, patient needs chemo, comes in on Monday and gets the education by an RN in an hospital based outpatient clinic and then begins treatment on Wednesday. Can we bill a 99211 for the Monday visit?
 

OCD_coder

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We are billing for the chemo teaching. We use the V65.49 as a second Dx for our tracking purposes.

We have a NP do our chemo-teaching and we are using the ASOG manual that states we can bill for chemo-teaching post-operatively. We don't know what the treatment will be until we know if the patient has cancer.
 
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mitchellde

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We were told that we can't bill for chemo teaching even if it is on a separate day from the actually chemo. For example, patient needs chemo, comes in on Monday and gets the education by an RN in an hospital based outpatient clinic and then begins treatment on Wednesday. Can we bill a 99211 for the Monday visit?
Are you billing for the physician office or the outpatient clinic? Is this nurse the hospital employee working in your hospital based clinic? It all makes a big difference.
*Physician office POS 11 and your nurse goes to the facility to do chemo teaching, you cannot charge for this at all.
*physician clinic hospital owned POS 22, the nurse does chemo teaching in the clinic setting, this cannot be billed by the physician office, but can be billed by the facility.
* physician office POS 11, nurse is doing chemo teaching in the office setting while a provider is on site this can be billed, either 99211 or possibly 98960.
 
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chemo teaching

This is an outpatient hospital clinic. The RN is employed by the hospital. So I was viewing it has an "internal resource" being used.
 

mitchellde

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Yes the facility can bill for this either you have "points" on your tool to assign this as a visit level for a 510 revenue center, or some other way to account for this that corresponds to a visit level.
 
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the acuity form we have does not have a "spot" or any points allocated to teaching. so if the RN spends "more time" than her visit level would probably be higher than a 99211, correct? The RNs spend an average of 30-60 minutes on chemo teaching.
 

mitchellde

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Ok what you need is to create a "spot" for chemo teaching, you cannot assign a visit level based on time. You can do something such as:
chemo teaching basic = 99211
chemo teaching moderate = 99212
chemo teaching advanced = 99213
and have criteria as to what each level consists of. I know our chemo nurses had different levels based on the patients expected course of treatment and diagnosis.
So you will need to have an addition made to the acuity sheet you currently have before you can begin charging for it.
 
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mitchellde

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Ok what you need is to create a "spot" for chemo teaching, you cannot assign a visit level based on time. You can do something such as:
chemo teaching basic = 99211
chemo teaching moderate = 99212
chemo teaching advanced = 99213
and have criteria as to what each level consists of. I know our chemo nurses had different levels based on the patients expected course of treatment and diagnosis.
So you will need to have an addition made to the acuity sheet you currently have before you can begin charging for it.
 
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chemo teaching

Thanks. Do you have a sample. I think our other problem is that we just purchased software to assist with assigning appropriate E/M levels and their people are sying no because it's included in the chemo admin code. We use Lynx now. I will need some concrete items to present to my boss and then I am sure he will run it past compliance.:)
If you have sample, you can sand to my email address which is my user name. Thanks so much!!!
 
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Ok what you need is to create a "spot" for chemo teaching, you cannot assign a visit level based on time. You can do something such as:
chemo teaching basic = 99211
chemo teaching moderate = 99212
chemo teaching advanced = 99213
and have criteria as to what each level consists of. I know our chemo nurses had different levels based on the patients expected course of treatment and diagnosis.
So you will need to have an addition made to the acuity sheet you currently have before you can begin charging for it.
Do you have a sample of what your nurses used?
 

mitchellde

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I must have missed this 2 years ago so sorry! It looks like your system is geared to physician E&M and not facility. A facility can charge for every patient encounter, and if not done on the same day as chemo admin then it is not bundled. I can look to see if I still have this but it is a tool the entire facility used not just the chemo unit.
 

mitchellde

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Ok, I thought I was losing it! I will need to see if I have a copy of that portion of the tool we used. Like I said we had a generic tool used by all departments, it had a section on it for chemo teaching, I will see if I have that and if not if I can reconstruct it. However I am going on a vacation trip to the river which my electronic gizmos are not welcome at! So it will take me a bit.
 
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I was told that "teaching" is incorporated in the adminsitration and it doesn't matter when the chemo was performed if it was performed on a different day than the teaching. I still think we should be able to charge for the hosptial resource that we used.

We routinely don't provide teaching because the physician office does it and I would think that is emcompassed in their E/M level. But when we do it, we can't charge for it??
 
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