Wiki Radiation Oncology Coding

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kaleeh@hotmail.com

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Hello,

In the radiation oncology practice that I work, most of the patients we see our prostate patients, therefore when the patient finishes their radiation treatment, our doctor orders a PSA to be done at 6 wks, 6 months, and a year following their treatment. We send our patients to an outside lab to have the PSA drawn and do not bill for it. My question is... when the patient follows up for their PSA results, we charge another E/M follow-up code unless it falls in the global period for Medicare plans. I am needing further clarification if this is correct to bill for the office visit for the results?

I am also needing to know.. if the patient comes in for a consult for radiation therapy and the doctor orders outside imaging, the patient will follow-up after their imaging to go over the results. Would the follow-up visit be included in the consult and not be billable for an additional follow-up charge?

Thank you!
 
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kaleeh@hotmail.com said:
Hello,

In the radiation oncology practice that I work, most of the patients we see our prostate patients, therefore when the patient finishes their radiation treatment, our doctor orders a PSA to be done at 6 wks, 6 months, and a year following their treatment. We send our patients to an outside lab to have the PSA drawn and do not bill for it. My question is... when the patient follows up for their PSA results, we charge another E/M follow-up code unless it falls in the global period for Medicare plans. I am needing further clarification if this is correct to bill for the office visit for the results?

I am also needing to know.. if the patient comes in for a consult for radiation therapy and the doctor orders outside imaging, the patient will follow-up after their imaging to go over the results. Would the follow-up visit be included in the consult and not be billable for an additional follow-up charge?

Thank you!
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Hello!

Yes, you can bill the E/M visit for 6 months and 1 year. You wouldn't bill the 6 week visit, because E/M is bundled into treatment management 77427 for 90 days following completion of treatment.

I am assuming that the doctor is doing more at the 6 month and 1 year visit than just giving PSA results. My radiation oncologists will also ask about any symptoms the patient might be having following prostate radiation (urinary issues, erectile issues, skin issues, etc.) and depending on the results coordinate as needed with other physicians such as medical oncology and urology.

The same with the imaging ordered at the consult - I assume that the doctor is doing more than just reviewing the imaging results. Based on the imaging results, the physician and patient will discuss treatment options going forward. Maybe they'll decide that the patient should receive chemotherapy first, or maybe they'll need concurrent chemo, or maybe the doctor will recommend surgery followed by radiation, or brachytherapy, etc.

Radiation oncology has minimal E/M compared to other specialties, because it's mostly bundled into the treatment management codes. However, the types of pre-treatment and post-treatment (after 90 days) visits you mentioned above are generally pretty typical.

By the way, I have a Facebook group for radiation oncology coders and billers. You're welcome to join if you'd like. I think we're over 330 members now - usually there's someone who has the knowledge to answer any rad onc questions that come up. https://www.facebook.com/groups/radiationoncologycoders/
 
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