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Follow up after breast biopsy?

  1. #1
    Location
    Woodbridge, Virginia
    Posts
    70
    Default Follow up after breast biopsy?
    Medical Coding Books
    WE HAVE A PATIENT THAT HAD A BREAST BIOPSY, CPT 19125 WITH THE DX OF BREAST MASS 611.72. THIS SURGERY HAS A 90 DAY GLOBAL PERIOD

    THE PATH REPORT CAME BACK AS BREAST CANCER AND THE PATIENT CAME IN FOR AN EXTENDED VISIT FOR THE SURGEON TO GO OVER THE PATH REPORT AND TO DISCUSS THE UPCOMING SURGERY.

    CAN I CHARGE FOR THIS VISIT SINCE THE PATIENT NOW HAS A DIFFERENT DIAGNOSIS? MY INSTINCT IS TELLING ME THAT IT IS A POST OP VISIT REGARDLESS, BUT THEN I MAY BE WRONG.

    THANKS FOR YOUR HELP!

  2. #2
    Location
    Seacoast- Dover New Hampshire
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    609
    Default
    I would code it by the path report. You might want to look at the modifier 58 with the office visit. I will be interested in the other replies.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Location
    Columbia, MO
    Posts
    12,527
    Default
    You cannot use a 58 modifier for an office visit code, and the dx of breast mass is not truely a different dx it was a symptom of the diefinitive dx of breast cancer, what you have is a post op encounter which is part of global and not billable.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Seacoast- Dover New Hampshire
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    609
    Default
    Wouldn't the visit after the bx be the visit to have more surgery because of the diagnosis? Now, a plan has to be made.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
    Location
    Columbia, MO
    Posts
    12,527
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    It is, however it is still part of the global, just the same as complications are a part of global. I really see no way around it. In the Cancer Center, after the surgeon received the results, he would send the patient to the oncologist for the discussion of the future which could be billed by the oncologist. However for the surgeon it is global.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by mitchellde View Post
    You cannot use a 58 modifier for an office visit code, and the dx of breast mass is not truely a different dx it was a symptom of the diefinitive dx of breast cancer, what you have is a post op encounter which is part of global and not billable.
    I totally agree. Discussion of the path report is directly related to the surgical procedure and is therefore not billable.
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Location
    Woodbridge, Virginia
    Posts
    70
    Default
    Thanks to everyone for your help!

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