Wiki Hospital admission and chemo same day

[tonplair@gmail.com]

A patient came in one day in the office and recieved chemo treatment and was later admitted to hospital that same day we first file to medicare without the 25 modifier and they bundle it with the chemo and we later did a redetermination and had them to add the 25 but they still denied it because they are saying when performing the procedure that are related to chemo such as 96413, 96411, 96416, 96375, 96361, and 96368 therefore it is bundled with those service. Can someone tell me if this is correct what medicare is saying or should it be appeal further? or how this should have been correctly billed.

 

[alannae]

The E&M with the 25 modifier is correct. You will need to appeal with medical records and prove that the E&M code submitted is indeed worthy of separate reimbursement. I would send the physician's dictated hospital admit (H&P) docs and the chemo orders/notes. You may also wish to include this 'white paper' from ASCO. http://www.asco.org/ASCOv2/Departme...oding with Drug Infusion Services 3-10-10.pdf

I have used this to appeal with other payers (not Medicare, yet).

Good luck!

Alanna