Results 1 to 3 of 3

E/M Visit for outpatient hospital

  1. Default E/M Visit for outpatient hospital
    Exam Training Packages
    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
    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 11:14 AM.

    Debra A. Mitchell, MSPH, CPC-H

  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.

Similar Threads

  1. difference between ambulatory visit and outpatient visit
    By in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-25-2014, 05:08 AM
  2. Inpatient hospital with outpatient office visit different specialty
    By sasharea in forum Ophthalmology/Optometry
    Replies: 2
    Last Post: 02-09-2012, 12:20 PM
  3. Outpatient Hospital Visit Documentation
    By jcevans in forum Outpatient Facilities
    Replies: 3
    Last Post: 12-22-2011, 07:38 PM
  4. Replies: 0
    Last Post: 08-18-2010, 02:47 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.