Wiki Coding help - seen and charged

[Revenuecycle]

Can someone help me to the coding of this day...i am new to this-

Patient is seen and charged for the following codes for that visit:
99213, J9190, 96416 and E0781. How do I bill correctly...modifiers if so which one?

Also, a general coding question if billing the 5FU drug with an office visit do we need a modifier on the 5FU drug or OV?

 

[dimmitta]

Hope this helps

I would add a 25 modifier to the OV if it was a separately identifiable service per CPT guidelines. As for the other code they would not need a modifier. I do know that we bill for the supplies as well (A4222) that are used to set up the chemo pump.

 

[Revenuecycle]

supplies

Are you reimbursed for supplies. We almost never get payment on those codes.

 

[mitchellde]

You cannot code an OV on the same day as Chemo admin, also the first-listed dx for a visit for chemo is a V58.1x dx code

 

[dimmitta]

Office visit same day as Chemo administration

You cannot code an OV on the same day as Chemo admin, also the first-listed dx for a visit for chemo is a V58.1x dx code

Yes, you can bill an office visit on same day as Chemo admin, if it was separately identifiable service. If the patient is seeing the doctor for some other reason than to discuss their chemo treatment plan then a separate E/M code would be appropriate to bill with a 25 modifier.

However, you are correct that an OV cannot be billed on same day if the only reason patient is there is for the chemo administration.

 

[dimmitta]

supplies

Are you reimbursed for supplies. We almost never get payment on those codes.

I know that we get payment from Medicare/DMERC for the supplies but I don't believe we get payment on those from BCBS. Some commercial carriers will pay and some will not.