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clinic visits

  1. Default clinic visits
    Medical Coding Books
    I'm not sure if I am posting this in the correct section, but I have a question about clinic visits.

    I work in an outpatient cancer center. There are two sides to our clinic, there is the clinic side that is operated by a private clinic, then there is the infusion side that is operated by hospital employees. There are times when we have patients go to the clinic side to see the doctor, then they are sent over to the infusion side for their chemo, fluids or blood, then something happens and the doctor is called to come see the patient again. Now, I have been told that the infusion side can't charge a 99211 on the same day. To me, it just seems as though money is being lost.

    Could someone please clarify this for me?

  2. #2
    Hopefully I am understanding your scenario correctly.

    Doctor provides and E/M service in his office, patient goes across the hall has chemo, something happens and they call the doctor over to re-evaluate the patient.

    If your provider is documenting his 2nd visit, this information can be combined with the first visit and the level of service would be based on all the information together.

    So if the scheduled visit levels out to a 99213, the doctor goes over sees the patient again and documents a new problem (additional MDM), additional elements of HPI, or additional elements of exam this would be added to the first visit and could put it up to a 99214 or even 99215 depending on what is documented. It won't always bump the level up, so just doing a second visit doesn't give the green light to start upping the levels. These visits need to be re-leveled each time in order to be compliant.

    I hope this makes sense,

    Laura, CPC, CEMC

  3. #3
    Columbia, MO
    Are you billing outpatient facility or physician?

    Debra A. Mitchell, MSPH, CPC-H

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