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Coding help - seen and charged

  1. Default Coding help - seen and charged
    Exam Training Packages
    Can someone help me to the coding of this day...i am new to this-

    Patient is seen and charged for the following codes for that visit:
    99213, J9190, 96416 and E0781. How do I bill correctly...modifiers if so which one?

    Also, a general coding question if billing the 5FU drug with an office visit do we need a modifier on the 5FU drug or OV?

  2. #2
    Default Hope this helps
    I would add a 25 modifier to the OV if it was a separately identifiable service per CPT guidelines. As for the other code they would not need a modifier. I do know that we bill for the supplies as well (A4222) that are used to set up the chemo pump.
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

  3. Default supplies
    Are you reimbursed for supplies. We almost never get payment on those codes.
    Finance Analyst

  4. #4
    Location
    Columbia, MO
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    Default
    You cannot code an OV on the same day as Chemo admin, also the first-listed dx for a visit for chemo is a V58.1x dx code

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default Office visit same day as Chemo administration
    Quote Originally Posted by mitchellde View Post
    You cannot code an OV on the same day as Chemo admin, also the first-listed dx for a visit for chemo is a V58.1x dx code
    Yes, you can bill an office visit on same day as Chemo admin, if it was separately identifiable service. If the patient is seeing the doctor for some other reason than to discuss their chemo treatment plan then a separate E/M code would be appropriate to bill with a 25 modifier.

    However, you are correct that an OV cannot be billed on same day if the only reason patient is there is for the chemo administration.
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

  6. #6
    Default supplies
    Quote Originally Posted by smsullivan View Post
    Are you reimbursed for supplies. We almost never get payment on those codes.
    I know that we get payment from Medicare/DMERC for the supplies but I don't believe we get payment on those from BCBS. Some commercial carriers will pay and some will not.
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

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