Oncology & Hematology Coding Alert

Question: A gynecologic oncologist who also performs chemotherapy administration sees a patient during the postoperative period and performs an E/M visit. Should modifier -24 be appended to the E/M visit? Arizona Subscriber Answer: You should use modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) when a physician needs to indicate that an E/M service was performed during a postoperative period for reasons unrelated to the original procedure. In the case described, appending modifier -24 to an E/M service indicates that the physician performed the chemotherpay service during the postoperative period. Thus, it would seem to fit the definition as a "reason unrelated to the original procedure."

Frequently, gynecologic oncologists perform the primary surgical procedure to treat a cancer diagnosis and then prescribe and follow up with chemotherapy. In addition to modifier -24, you must use the appropriate cancer diagnosis code. For example, a patient has a total hysterectomy after being diagnosed with ovarian cancer. During the postoperative global period, the physician evaluates the patient in the office, not for postoperative follow-up but to determine and discuss the chemotherapy regimen. You should bill the appropriate office visit code with modifier -24 and report the ovarian cancer (183.0) diagnosis. If, however, chemotherapy is planned as part of the patient's overall treatment regimen prior to the surgery, the office visit should not be billed separately.