Q&A: Reporting an E/M service with a scheduled drug administration service

Q: Is it ever appropriate to report an E/M service on the same date of service as a scheduled drug administration service?

A: Yes. To report an E/M service on the same date of service as a scheduled drug administration service, the E/M service must be significant and separately identifiable from any routine care that is otherwise part of the drug administration service.

This is true regardless of whether the service is performed by a physician, a non-physician practitioner, or a nurse. This usually means that the patient presents with a sign or symptom that is atypical and requires a unique assessment. This may require the nurse to call a physician and check if he or she can proceed with drug administration services scheduled for the day. The patient may require additional laboratory work, a blood draw, or other therapeutic services such as treatment for a rash. All of this needs to be documented in the medical record.

The E/M service should be coded with a modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to indicate that it was a significant and separately identifiable service.

Editor’s note: Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington D.C., and Valerie A. Rinkle, MPA, lead regulatory specialist with HCPro, a Simplify Compliance brand, in Middleton, Massachusetts, answered this question during the HCPro webinar, “Injections and Infusions: Resolve Frequent Coding and Billing Challenges.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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