Wiki E&M with Chemo

[aschaeve]

Are there guidelines out there for when you would and would not bill and E&M on the same day as chemo? We have providers who will see the patient periodically before chemo to review their status. I know that if there is a new problem the provider addresses or a change in medication, and if documentation supports, that would support the E&M. What about just reviewing the medication given for that visit?

Thanks,

Alicia, CPC

 

[trarut]

If the provider is simply clearing the patient for treatment that day, it is not a separately identifiable visit and is not billable. Otherwise, the provider's documentation should show that the purpose of the visit is to assess the cancer and status of disease because the patient has new or worsening symptoms or there are NEW pathology/test/scan results. The visit could be to address other conditions the provider is managing.

As an auditor recently told me: Omit anything related to the treatment or clearance for treatment from the Assessment and Plan and, if you still have enough to support a visit, that's what you'll use to determine the E/M level.