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Thread: E/M Visit for outpatient hospital

  1. #1

    Default E/M Visit for outpatient hospital

    AAPC: Back to School
    We are having a debate to determine whether these scenarios warrant an E/M visit for our infusion center. We are a hospital based. Note, no physician was present, only communicated over the phone.

    1.Patient presented for chemo treatment and received a blood transfusion. Along with adding a modifier to 36430.
    2.Patient presented for chemo treatment and had a reaction. Received Decadron and Benedryl and chemo restarted with no incident.
    3.Patient presented for chemo and was administered pain meds along with the chemo.
    4.Patient presented for chemo and treatment held due to lab values

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    To be able to charge an E&M in addition to the procedure, the utilization of resources must be over, above and beyond what is necessary for the procedure. When a patient is scheduled to come in for a chemo infusion, then just as for the physician we know why the patient is there and all resources consumed are a part of the infusion. so for #1, I say no. and # 2, you would need to justify what was expended outside the norm, the nursing time is inclusive to the treatments. so with no further information I say no, and same for #3 I say no, #4 however you bill a facility level as no treatment was rendered, and the facility should have something on the assessment tool to account for this so that a level may be charged.
    Last edited by mitchellde; 02-24-2011 at 10:14 AM.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default E/m visits

    For #2, a typical scenario would be, patient comes in for chemo, c/o of "throat feels funny" during infusion and it is determined patient is having a minor reaction. RN calls dr to give update of what patient says, dr. orders benadryl and decadron. RN administers drugs, assesses patient. Patient states, feel better, chemo resumes.

    OR patient comes in for chemo, and has low magnesium levels based on lab results. Dr is called, gives order to provide Mag and continues with chemo.

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