Pediatric hematology/ onc

Tenicajo

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Hello,
I am looking for resources for pediatric hematology and oncology. I have physicians who are billing for chemo on the same day as E/M. They are under the impression that they can bill level 4/5 visit since they are monitoring the patient for toxicity and deciding if they should proceed with the chemo. I am telling them they can't bill an E/M and chemo on the same day unless the patient has a new issue. Since the patient is coming in for chemo, the workup prior to the chemo is included. I would appreciate any help with this. Thank you.
 

jrs7117

Networker
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Plant City, FL
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E/m and chemo

I bill for an oncology office. You can bill for the visit and the chemo as long as there was an actual visit. You can not bill an E/M for the monitoring of chemo alone. If the patient has a office visit and then chemo, you need to add -25 to the E/M. They just don't want physicians trying to bill for "visits" when they are only monitoring the patient. If I am wrong, someone please tell me. The latest update I read, (and I do not know where it is right now) said that it does not have to be a separate problem, I always thought it did. I have been working here for 3 years and have never ran into a problem...


Julie Williams, CPC, CHONC
 

Tenicajo

New
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I bill for an oncology office. You can bill for the visit and the chemo as long as there was an actual visit. You can not bill an E/M for the monitoring of chemo alone. If the patient has a office visit and then chemo, you need to add -25 to the E/M. They just don't want physicians trying to bill for "visits" when they are only monitoring the patient. If I am wrong, someone please tell me. The latest update I read, (and I do not know where it is right now) said that it does not have to be a separate problem, I always thought it did. I have been working here for 3 years and have never ran into a problem...


Julie Williams, CPC, CHONC
Hi Julie,

Do you happen to remember the tittle of the article? I also sent you a private message. Thanks
 

twtcpc

Guru
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195
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Hello,
I am looking for resources for pediatric hematology and oncology. I have physicians who are billing for chemo on the same day as E/M. They are under the impression that they can bill level 4/5 visit since they are monitoring the patient for toxicity and deciding if they should proceed with the chemo. I am telling them they can't bill an E/M and chemo on the same day unless the patient has a new issue. Since the patient is coming in for chemo, the workup prior to the chemo is included. I would appreciate any help with this. Thank you.
This is a good resource for oncology from AHIMA https://engage.ahima.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=277f74bb-0220-42f3-9798-2e7c2d2798ed

Check slide 112-113
 
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