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examples of e&m for hema/onc office visits

  1. #1
    Question examples of e&m for hema/onc office visits
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    could anyone tell me where I might go to find examples of evaluation and management codes for office visits for hematology/oncology?

  2. #2
    Default
    Can you be more specific please ? Do you mean examples of when you would bill just an E/M ? Not sure if i could help being that i am new at this but wouldn't hurt to have a look.

  3. #3
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    My specific question from the physician was the following:

    If I see a patient for Acute L L with current chemo treatment what would my level be? level for follow up after 6 months of being off chemo for check? level for acute L L on chemo with issues the day of the visit?

  4. #4
    Default
    Again i am no oncology coding expert but i would say" level for acute L L on chemo with issues the day of the visit"

    It is my understanding that chemo has no global, therefore, if a problem from or related to the treatment arose then you could bill the appropriate E/M level. If the patient is on chemo and coming in for treatment and has a complication then you can bill both with -25.

    If a significant separately identifiable evaluation and management service is performed, the
    appropriate E & M code should be reported utilizing modifier 25 in addition to the
    chemotherapy administration or non-chemotherapy injection and infusion service. For an
    evaluation and management service provided on the same day, a different diagnosis is not
    required.




    http://www.lamedicare.com/provider/m...coverage27.pdf

    Not really sure if this is what your physician is talking about. Hope this helps or maybe someone else could shed some light !!

  5. #5
    Question
    what level is my question. like 99213,99214,99215 examples of each of these not necessarily that dx code but some sort of cancer dx

  6. #6
    Default
    The level will depend on the documention he provides of PE, History MDM etc. I don't have any examples of cancer per say but if you look in back of the CPT book they give you examples of the different levels. Sorry i couldn't be more help.

  7. Default
    I, too, am frustrated regarding the availability of E&M codes for hematology/oncology. My doc does NOT do treatments in the office, yet all references assumes he does!

    My question: When a patient is seen for an E/M visit, and the doc writes the chemo orders, can he get "credit" for this through a specific code?

  8. #8
    Default
    Quote Originally Posted by Linda Bigwood View Post
    I, too, am frustrated regarding the availability of E&M codes for hematology/oncology. My doc does NOT do treatments in the office, yet all references assumes he does!

    My question: When a patient is seen for an E/M visit, and the doc writes the chemo orders, can he get "credit" for this through a specific code?
    So he is seeing these patients and sending them to an outside facility to recieve the actual chemo ??

  9. #9
    Location
    Milwaukee WI
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    Default I'll try
    Okay .. just off the top of my head because this is NOT my specialty.

    99212 you need SF MDM and either a PF exam or PF history:
    Patient w/ acute L L here for F/U. Last Chemo treatment 2 months ago. Reports few side effects. Labs: (report of bloodwork), shows improvement/worsening since last treatment. Return F/U visit in 1 months, with repeat labs.

    For 99213 you need low MDM, and either EPF history or EPF exam:
    Patient w/ acute L L here for F/U. First diagnosed 7-1-08; last chemo trmt 2 weeks ago. Nausea/vomiting only within 2 days of trmt. ROS: appetite otherwise good; no rashes, fever, bruising. Labs: (report) CXR (report). Rx for control of nausea. Order for continued chemo. Return F/U visit 1 month, with repeat labs & CXR.

    Hope that helps. If you want to post one or two of your actual notes (scrubbed, of course), we could help you determine the level of E/M.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 09-18-2009 at 05:55 PM.

  10. #10
    Default
    Quote Originally Posted by stacy pauley View Post
    My specific question from the physician was the following:

    If I see a patient for Acute L L with current chemo treatment what would my level be? level for follow up after 6 months of being off chemo for check? level for acute L L on chemo with issues the day of the visit?
    Having worked in Hem/Onc for almost the last 6 years, I've seen quite a few E/M's come across my desk. Coding for oncology E/M is really no different than coding for any other type of E/M. You have to remember that the physician still has to meet different levels of obtained history, physical exam, medical decision making, and then there's also time.
    Let's say one of my doctors sees a patient with ALL for a Chemo check up. It's been 3 weeks since the last time the patient was seen and the doctor spends 15 minutes reviewing any sympotms or issues the patient is having from the chemo, but performs an expanded problem focused exam and the continued decision making is of low to moderate complexity. The physician can charge a 99213. If the physician however spends an additional 30 minutes coordinating care with another physician, he/she may bill a 99214. The E/M level is based on what the doctor does and actually documents. It always helps for the doctor to document total time spent with the patient and coordinating care as well as how much of that time was spent face-to-face with the patient. It may mean a level 4 instead of a level 3. Good Luck!

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