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Thread: E/M billing for outpatient chemo

  1. #1

    Default E/M billing for outpatient chemo

    AAPC: Back to School
    Ok-here's the situation. We have a doctor that INSISTS he can bill a 99211 for his patients that are getting outpatient chemo at the local hospital because "sometimes the chemo dept needs to call him and ask him something re: the chemo orders".??? He sees the patient the day before the chemo and bills an appropriate E/M code for that visit. His nurse has faxed over all orders for the next day's chemo. Occasionaly the doctor gets a call because the patient's having a reaction to the chemo and he may order an injection. He does not go over to the hopsital and the patient does not come that same day to see him. He bills this each and every time one of his patient's is getting chemo at the local hospital whether he gets a call from the hospital or not. We cannot bill stand-by as he is seeing other patient's during this time. We may have to use the "F" word with him (fraud) to get him to take us seriously, any other advice? Once we realized what he was doing we started holding all his hospital charges and not putting them into our billing system.

  2. #2


    I think if you and/or the provider review this article it may clear it up.


  3. #3


    You definitely can't bill an e/m charge when he didn't see or even talk to the paient. There are codes for phone calls, but I doubt this scenario would work.

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