An insurance company has refused to pay for an Evaluation and Management (E/M) Office or Other Outpatient Services code (eg, 99214 ) and procedure code 90765 (DELETED IN 2009), Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, when they are both reported on the same date of service. They state the office visit is inclusive to the procedure. What is the appropriate way to report these services when the two (ie, the E/M visit and the intravenous infusion) are unrelated? ...
Subscribe or sign in to view the full article.
Article Overview
This short coding guidance article addresses a common reimbursement dispute involving same-day evaluation and management and infusion services. It explains the general CPT guidance, highlights the role of payer policy, and is relevant to coders, billers, and compliance staff who handle office visits and infusion reporting.
Why This Topic Matters
Understanding how same-day E/M and infusion services are reported helps practices reduce denials and align claims with both CPT guidance and individual payer requirements.
What You Will Learn
- How the article frames same-day office E/M and intravenous infusion reporting
- Why payer policies may differ from general CPT guidance
- What broad type of guidance applies when services are unrelated on the same date of service
- Which kinds of claims are commonly affected by this issue
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com