Oncology & Hematology Coding Alert

Answer: Global billing is a concept that provides payment of a single fee for all necessary services furnished in connection with a surgical procedure, including preoperative care, the surgery itself and related postoperative care. In general, the surgeon would not code and bill separately for office visits performed within the global period, which potentially would be up to 90 days after surgery, according to Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a coding consulting firm in Dallas, Ga.

The oncologist performing the chemotherapy, who was not the operating surgeon, would bill for the chemotherapy treatments (96400-96549) and evaluation and management (E/M) services (99211-99215) as performed and documented.

Your question also poses a medical-necessity issue regarding the need for two physicians to follow the progress of the chemotherapy. Because only one physician or group typically is responsible for the patients course of chemotherapy, most payers will reimburse only the physician administering the chemotherapy for patient visits to assess the status of this treatment, and will consider the gynecologist/oncologists services to be part of the postoperative. If the medical oncologist is also coding for E/M in conjunction with chemotherapy treatments, then these services would include an assessment of the patient for possible reactions or side effects to the chemotherapy.

If the surgeon treats as opposed to assesses the patient during the postoperative period for a condition unrelated to the surgery, modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) may be appended to the E/M code to indicate that the service provided was unrelated to the surgical procedure. This may be appropriate if the surgeon treats the patient for a complication due to the chemotherapy, but ultimately, use of this modifier may prompt a request for medical records that must clearly support the medical necessity of the surgeon monitoring this condition rather than the oncologist. In this situation, the primary diagnosis clearly must reflect the nature of the ailment under treatment and not the malignancy requiring surgery and chemotherapy.