post op consultation

rykin7609

Networker
Local Chapter Officer
Messages
85
Location
Alvin, TX
Best answers
0
I have a surgeon who less than 30 days prior perfomed a 19125 for bloody discharge from left nipple. Excised the duct and submitted it to pathology. Now the surgeon wants a 99215 for a 45 minute, 100% consultation for DCIS.

Would the 99215 be billable with a 24 modifier? Nothing documented about carcinoma in the procedure visit, everything was nipple discharge. However, because it is the same anatomy, would that place this encounter unbillable?

Appreciate any feedback
 

laurelholland

Contributor
Local Chapter Officer
Messages
13
Location
Grangeville Idaho
Best answers
0
You only need the modifier if within the global days of the procedure. Sounds like pathology came back as DCIS and supports billing a consult. Add 57 if decision for surgery is noted.
 

mhstrauss

True Blue
Messages
1,240
Location
Baton Rouge
Best answers
0
I have a surgeon who less than 30 days prior perfomed a 19125 for bloody discharge from left nipple. Excised the duct and submitted it to pathology. Now the surgeon wants a 99215 for a 45 minute, 100% consultation for DCIS.

Would the 99215 be billable with a 24 modifier? Nothing documented about carcinoma in the procedure visit, everything was nipple discharge. However, because it is the same anatomy, would that place this encounter unbillable?

Appreciate any feedback

It is billable with modifier 24. The "same anatomy" issue does not preclude the visit from being billed. This is a separate issue, and therefore not included in the global period for the original surgery.
 
Top