newly Diagnosis of Breast CA

[dmcbass]

Patient had a Biopsy of Breast now returns to office to go over test results, with a new diagnosis of Breast Cancer. The Doctor spends an hour going over the test results with the patient, setting up an appt with oncologist, requesting a copy of patient films as well as pathology report to take to oncologist.
Can we bill a Prolonged Service code with a Post op code?

 

[mitchellde]

This is global to the procedure if the procedure has post op global days therefoe not billable. If the provider has assigned 0 global days then as long as the physician documents time spent and you have 30 minutes more than the visit level then yes. But I think it will be global sorry.

 

[lisigirl]

Actually, you can bill whatever E/M this levels out to and just add the -24 modifier. If the entire hour was spent counseling the patient, then you can bill 99215-24.

The -24 modifier is to be used during the global period when (a) the visit is unrelated to the surgery or (b) for disease management. Due to the fact that this is a new diagnosis of breast cancer, the surgeon was seeing the patient to go over the next steps for disease management (rather than post-op care).

Lisi, CPC

 

[mitchellde]

Actually, you can bill whatever E/M this levels out to and just add the -24 modifier. If the entire hour was spent counseling the patient, then you can bill 99215-24.

The -24 modifier is to be used during the global period when (a) the visit is unrelated to the surgery or (b) for disease management. Due to the fact that this is a new diagnosis of breast cancer, the surgeon was seeing the patient to go over the next steps for disease management (rather than post-op care).

Lisi, CPC

Hmmm I am not certain about the different dx, I see where you are going but I am not entirely on board. I do not see this as a different dx, JMO

 

[lisigirl]

I will try to find the info on Medicare's website. It doesn't have to be a different diagnosis, the documentation just has to be clear that the visit was for disease management and not post-op care.

I bill like this in our office when a lung biopsy comes back positive and the patient comes in to discuss the results and treatment options.

Lisi