Oncology & Hematology Coding Alert

Question: During a scheduled bone marrow biopsy, our oncologist typically performs a patient exam, and he knows that is bundled with and supports the biopsy procedure. However, what if the oncologist discovers an unrelated problem? Can he bill for a separate E/M encounter? Minnesota Subscriber Answer: Yes, a new complication or problem may require another E/M encounter above and beyond what is required by the biopsy.

For example, during the office visit, the patient may report nausea with vomiting unrelated to the biopsy (787.01), which may require a GI workup in addition to what you would do for a bone marrow biopsy. In this case, don't forget to make good use of modifier -25 (Significant, separately identifiable E/M service ...) when another patient-care issue arises during the scheduled biopsy. However, it is key to remember that if the scenario is flip-flopped, that is, the physician decides to do a biopsy during the course of a regular E/M visit, then you should use modifier -57 (Decision for surgery) instead of modifier -25.