Needle breast biopsy with post op office visit

debarr

New
Local Chapter Officer
Messages
8
Location
Buckhannon, WV
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A doctor did a needle breast biopsy on a patient which has a 10 day global. They are brought back to the office to discuss results. If nothing is found from the biopsy-there will be no charge. They want to charge an office visit if it is cancer because they are spending up to an hour discussing options and treatment plans with the patient. Is that billable with a counseling code? I need opinions.
 

debarr

New
Local Chapter Officer
Messages
8
Location
Buckhannon, WV
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We have a person that states you can bill based on time (E&M) visit with a modifer 58 (staged or related procedure or SERVICE)-service they are saying. I didnt think you could use 58 modifer on and E&M visit. Any opinions?
 

JSYLVAIN

Contributor
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17
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Needle biopsy codes 19100, 19102 & 19103 do not have global days. We do a follow up visit when needed, billable, but do not take copay for that visit as standard office policy.
 

Monika Liddle

Expert
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356
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The office copay is an agreement between the insurance company and the patient. I believe you should be collecting the copay if you bill the insurance company.
 

Zina

Networker
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40
Location
Somers Point, NJ
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You can bill the visit with most insurances, just use the breast cancer dx, and add modifer -24 if needed. You should be careful about the copay issue, some insurance companies view that as a violation of your contract with them.
 
Messages
3
Location
Coeur d Alene, ID
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Since this is a "new diagnosis" a visit can be billed with the new diagnosis and a 24 modifier on the visit. This is not related to the post op care of the procedure/biopsy. And...agree if there was not a finding on the biopsy the visit would be related to post op care and not billable.
 
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