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Needle breast biopsy with post op office visit

  1. Default Needle breast biopsy with post op office visit
    Medical Coding Books
    A doctor did a needle breast biopsy on a patient which has a 10 day global. They are brought back to the office to discuss results. If nothing is found from the biopsy-there will be no charge. They want to charge an office visit if it is cancer because they are spending up to an hour discussing options and treatment plans with the patient. Is that billable with a counseling code? I need opinions.

  2. #2
    Location
    Columbia, MO
    Posts
    12,861
    Default
    no it is global you may not bill.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    We have a person that states you can bill based on time (E&M) visit with a modifer 58 (staged or related procedure or SERVICE)-service they are saying. I didnt think you could use 58 modifer on and E&M visit. Any opinions?

  4. #4
    Location
    Columbia, MO
    Posts
    12,861
    Default
    You are correct, you may not use the 58 for an E&M code, E&M codes may use only E&M modifiers.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Needle biopsy codes 19100, 19102 & 19103 do not have global days. We do a follow up visit when needed, billable, but do not take copay for that visit as standard office policy.

  6. #6
    Location
    Columbia, MO
    Posts
    12,861
    Default
    good point, what code was being used for the needle bx?

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    The office copay is an agreement between the insurance company and the patient. I believe you should be collecting the copay if you bill the insurance company.

  8. #8
    Location
    CHERRY HILL
    Posts
    38
    Default
    You can bill the visit with most insurances, just use the breast cancer dx, and add modifer -24 if needed. You should be careful about the copay issue, some insurance companies view that as a violation of your contract with them.

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