Hematology / Oncology, coded right.

Use 99205 for a new patient with severe, decompensated, or high-acuity disease, or for complex consult-style new-patient encounters where decisions about hospitalization, major surgery, drug therapy requiring intensive monitoring, or de-escalation of care are made. Real examples: a new patient referred for severe pulmonary hypertension where right-heart catheterization is planned; a new oncology consult for newly-diagnosed metastatic disease where systemic therapy is initiated; a new patient with decompensated heart failure where admission is considered. Time-based alternative is 60 to 74 minutes of total time on the date of the encounter. Beyond 75 minutes, add 99417 (commercial) or G0316 (Medicare) in 15-minute increments.

Use 99215 when the encounter genuinely required high-complexity decision-making: severe exacerbation or decompensation of a chronic illness, an acute or chronic illness or injury that poses a threat to life or bodily function, decision regarding hospitalization, drug therapy requiring intensive monitoring for toxicity, or extensive comorbidity management driving a high-risk decision. Real examples: a CHF patient with new bilateral leg edema and dyspnea where you considered emergency admission; a new-onset AFib with RVR you elected to manage outpatient with same-day rate-control titration; an oncology patient with febrile neutropenia. Time-based alternative is 40 to 54 minutes of total time on the date of the encounter.

G2211 is the continuity add-on. Append it to an office E/M (99202 through 99215) under one of two conditions: you are the continuing focal point for all of the patient's health care (the primary-care framing), OR you are the ongoing care provider for a patient's single serious condition or a complex condition (the subspecialty framing). Common eligible scenarios: a routine primary care follow-up for chronic disease management; an endocrinology continuity visit for diabetes; an oncology survivorship visit; a rheumatology disease-modifying-medication monitoring visit; a nephrology follow-up for CKD progression. Ineligible scenarios: one-time consults, urgent care visits, hospital follow-up where you are not the longitudinal provider, and visits where modifier 25 is appended to the primary E/M (explicitly prohibited).

Initial IV chemo infusion of the encounter, up to 1 hour. Add 96415 for each additional hour, 96417 for additional drugs.

Each additional hour of the same chemo drug.

Sequential chemo infusion of a different drug after 96413.

IV push chemo. Use 96411 for each additional push of a different drug.

First therapeutic non-chemo IV infusion at the encounter.

Each additional hour of the same therapeutic infusion.