E/m visits for chemo patients

[kathleeng]

Is there a max allowed office visits to be billed for a chemotherapy patient monthly? This is separate from their treatment days. I know for dialysis patients there are specific guidelines to billing office visits because they are bundled into one payment, so I'm curious if chemo falls into the same criteria but I'm having trouble finding the information on it.

 

[rachaelwilleford]

E&M limitations are specific to payer, but to my knowledge there is not a general limitation for office visits while under chemotherapy treatment.

 

[SIVAD63]

Is there a max allowed office visits to be billed for a chemotherapy patient monthly? This is separate from their treatment days. I know for dialysis patients there are specific guidelines to billing office visits because they are bundled into one payment, so I'm curious if chemo falls into the same criteria but I'm having trouble finding the information on it.

To bill both an E/M visit and chemotherapy services on the same DOS, there must be documentation to support both the medical necessity and the separate and distinct nature of the two patient services. A reason for the provider to see a patient outside of performing the chemotherapy infusion. Either “above and beyond or “separate and identifiable”.
Chapter 12, Section 30.5 MACs pay for evaluation and management services provided on the same day as the chemotherapy administration services or a nonchemotherapy injection or infusion service if the evaluation and management service meets the requirements of section §30.6.6