Wiki E & M on same day a Chemo


Maumee, OH
Best answers
I am having some issues with insurance companies denying (saying not seperatly identifiable) an E&M on the same day as chemo. Our docs not only have to verify that the patient is well enough to have the chemo but also wants to schedule a follow-up on the same day so that the already compromised patient does not have to return on multiple days for chemo and follow up. Any imput would be of great help
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The CMS manual even states that you may not charge a physician E&M on the same day as Chemo. The reason being that they have already assessed the patient for the necessity of the chemo and cannot charge for this again.
They are not looking at the necessity of the chemo, they are assessing if the patient is well enough for chemo and how the progression is coming of the treatment
I have been coding Medical Oncology for 17 years and have never seen anything stating that you cannot bill an E/M visit on the same day as Chemo. We do it for 54 physicians. The E/M visit is not just for if they can have chemo, it is usually also for the patients general progress, associated issues, etc.

It may be that the documentation does not support anything other thatn if the pt can have chemo. Are they requesting notes? Are you using the 25 modifier on your E/M visits when documented?