Hi fellow oncology coders,
I am having problems with medical necessity denials for E/M and chemo same day. Our doctors review labs and toxicity of patients prior to their treatment, but there may not be anything specifically wrong with the patient other than signs or symptoms like weakness, fatigue, and/or pain related to the tx/disease. Can you still code this as a separately identifiable service to the chemotherapy treatment? Some times we hold treatment, or change their tx; but if they are coming in specifically for the tx and we are reviewing the toxicities is that inclusive?
On another note if a patient is receiving chemotherapy that day are they automatically high risk (drug therapy requiring intensive monitoring for toxicity)?
Thanks
-Stephanie Thebarge, CPC
I am having problems with medical necessity denials for E/M and chemo same day. Our doctors review labs and toxicity of patients prior to their treatment, but there may not be anything specifically wrong with the patient other than signs or symptoms like weakness, fatigue, and/or pain related to the tx/disease. Can you still code this as a separately identifiable service to the chemotherapy treatment? Some times we hold treatment, or change their tx; but if they are coming in specifically for the tx and we are reviewing the toxicities is that inclusive?
On another note if a patient is receiving chemotherapy that day are they automatically high risk (drug therapy requiring intensive monitoring for toxicity)?
Thanks
-Stephanie Thebarge, CPC