Wiki follow up visit

[sbetts]

Hi everyone,

Here's the scenario... the surgeon did procedure 19110 (90 day global) with a diagnosis of breast cancer. Apparently when the pathology came back there was more extensive disease than originally thought so the patient was called back in to discuss the findings and counseling was done regarding a new surgery for the more extensive disease.

I know the 2nd surgery can be billed with a modifier however it's the office visit that I'm not sure how to bill or if it should even be billed. I know with Medicare, if you apply mod 24 they will not pay with the same diagnosis code as the original surgery. Would this office visit be included in the global period for the first surgery? If not, how do I bill it?

thanks for the help!

Shena Betts, CPC, RCC

 

[sheardmd]

There was a Coding Alert about this quite awhile ago that said that you could append the 24 modifier to the office visit in this situation and 58 for the surgery. Since that visit will probably be a lengthy one, I would make sure that your doctor documents face-to-face time in case you do need to show Medicare on appeal that this was more than just your typical post-operative visit.

 

[Peter Davidyock]

Melissa is correct.
I have a breast surgeon that runs into this exact scenario frequently.
The way you need to approach the decision process here is to address the global surgery package. Post operative care is simply just what it says, care for the surgery performed and nothing more. Incision care, dressing changes, complications such as infections, certain RX management. Things related to the recovery of "that" particular procedure.

Counseling and coordination of care to move forward to another more extensive procedure has nothing to do with the recovery from the current procedure. The same DX with a modifier 24 will be denied by Medicare and you will have to appeal with the visit notes. Make certain your physician has described the extent of the counseling and codes based on time. The physician does not have to dicatate a novel but the documentation must be concise enough to demonstrate the time spent. 50% of the time has to be spent on counseling and coordination of care. Start and stop times are not necessary but a statement in the notes stating time spent is required. IE: I spent 20 minutes with this patient 70% of that time was spent yada yada yada

 

[sbetts]

thanks! I knew Medicare would deny because of the same diagnosis so i wasn't sure if they would pay on appeal or consider it part of the global package.