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Coding Question - medication management

  1. #1
    Default Coding Question - medication management
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    I have an Oncologist that has asked the following: If a patient has labs done and after reviewing the labs he decides to change their chemo orders, is there a code that we can bill for high risk medication management? Can someone please help me with this?
    Thanks.

  2. #2
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    Unfortunately I've not yet found any coding for situations like this. If it's 31+ minutes after the E/M service, you could always try a prolonged service charge (99358 - 99359) but it would require there be face-to-face time at some point. Good luck!

  3. #3
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    chemo drug monitoring is accounted for in the complexity of an E&M. It could help drive the E&M up a level but if the dr doesn't have face-to-face time I'm not sure there is anything you could use to bill for this on its own.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  4. #4
    Location
    Grand Rapids, MI
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    Quote Originally Posted by earreid View Post
    If a patient has two drugs running at the same time (Chemo and IV Therapy) Do you code both or the Concurrent code as the initial drug?

    Also can 96416 be used with Chemo Infusion 15 min or less?
    I'm not sure what you mean by IV Therapy but two drugs running i.e. Leukovorin running concurrently, you would bill it as 96368. 96416 is for initiation of the pump only not a push 96411.

  5. #5
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    Nashville AAPC Chapter
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    96416 - the infusion has to run for more than 8 hours, so it would be a 96409 or 96411 as it is considered a push if it runs for 15 mintes or less.

    If Leucovorin is running concurrently into a different tubing into the patient, then yes you would use a 96368.

    Hope that helps.

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