Wiki Post Op Visits for Confirmed Cancer Diagnosis

[tloeb]

I am hoping to find an opinion regarding whether a post op visit after a surgery by the same physician that performed the surgery (ie: Hysterectomy) for pathology confirmed cancer can be billed as an E/M with a mod 24 when the visit entails discussion about whether the patient may or may not get adjuvant treatment and in turn involves a lot of time and explanation regarding the options. There is not a decision for chemotherapy at this point only discussion of options. Some of my providers feel that this is outside of the global surgical package however my research indicates that because this is not an unrelated diagnosis from the surgery nor is there a decision for an added course of treatment that it is in fact part of the global surgical package. Thank you for any input!

 

[thomas7331]

I would agree with your providers here that this is outside of the global package and warrants the use of the modifier 24. The CMS guidelines state that the global package does not include "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery", and while this is not an added course of treatment (at least not yet), the discussion of options for treatment of the cancer is certainly part of the care for the underlying condition.

The global surgical package is meant to mainly include management of the recovery from the procedure itself and/or any complications that are related to it. Anything physician work involving the treatment of the cancer, and not associated with the procedure itself, should be considered separate from the global package.

 

[csperoni]

Any postop appointment that turns into a discussion of treatment for the underlying condition with or without an added treatment is outside the global surgical package. A different diagnosis is not required for -24. I have used the quote @thomas7331 pulled from the Medicare global surgical booklet on MANY an appeal letter and/or audit. https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf
I will note - sometimes my providers just simply put in the note "refer to rad onc/hemonc to discuss treatment options". That documentation would be insufficient to warrant -24.