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.
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Wiki Needle breast biopsy with post op office visit
- Thread starter debarr
- Start date
mitchellde
True Blue
no it is global you may not bill.
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?
mitchellde
True Blue
You are correct, you may not use the 58 for an E&M code, E&M codes may use only E&M modifiers.
mitchellde
True Blue
good point, what code was being used for the needle bx?
Monika Liddle
Expert
- Messages
- 355
- Best answers
- 0
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
Guest
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.
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.