Post Op visit after positive margins on lumpectomy?

[RainyDaze]

We had a Medicare patient with a diagnosis of breast cancer go in for a lumpectomy, upon receiving the pathology report several days later, the patient's margins were positive and had to be scheduled for a return to the operating room.

My question, can we charge for a office visit with a 24 modifier or would it be considered a post op since she was already diagnosed with breast cancer??

If we can use the 24 modifier, what dx code would I use?

Thanks!

 

[crhunt78]

I probably wouldn't bill for the office visit unless it is obvious that the doctor did another complete exam, ROS, HPI, etc. Did he just go over the pathology results with her? If he looked at the incision site, etc. then I would say it's part of the post op but if he just went over the path results and documented time and counseling then you might be able to get away with the 24 modifier. It all depends on the documentation. You would have to use breast cancer as the dx.

 

[crhunt78]

One more thing....if the doctor did counsel the patient, you may be able to use the V code for counseling after the breast cancer diagnosis but he has to document that he counseled the patient on her options.