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newly Diagnosis of Breast CA

  1. #1
    Location
    St Louis West Chapter
    Posts
    4
    Default newly Diagnosis of Breast CA
    Medical Coding Books
    Patient had a Biopsy of Breast now returns to office to go over test results, with a new diagnosis of Breast Cancer. The Doctor spends an hour going over the test results with the patient, setting up an appt with oncologist, requesting a copy of patient films as well as pathology report to take to oncologist.
    Can we bill a Prolonged Service code with a Post op code?

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    This is global to the procedure if the procedure has post op global days therefoe not billable. If the provider has assigned 0 global days then as long as the physician documents time spent and you have 30 minutes more than the visit level then yes. But I think it will be global sorry.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Actually, you can bill whatever E/M this levels out to and just add the -24 modifier. If the entire hour was spent counseling the patient, then you can bill 99215-24.

    The -24 modifier is to be used during the global period when (a) the visit is unrelated to the surgery or (b) for disease management. Due to the fact that this is a new diagnosis of breast cancer, the surgeon was seeing the patient to go over the next steps for disease management (rather than post-op care).

    Lisi, CPC

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by lisigirl View Post
    Actually, you can bill whatever E/M this levels out to and just add the -24 modifier. If the entire hour was spent counseling the patient, then you can bill 99215-24.

    The -24 modifier is to be used during the global period when (a) the visit is unrelated to the surgery or (b) for disease management. Due to the fact that this is a new diagnosis of breast cancer, the surgeon was seeing the patient to go over the next steps for disease management (rather than post-op care).

    Lisi, CPC
    Hmmm I am not certain about the different dx, I see where you are going but I am not entirely on board. I do not see this as a different dx, JMO

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    I will try to find the info on Medicare's website. It doesn't have to be a different diagnosis, the documentation just has to be clear that the visit was for disease management and not post-op care.

    I bill like this in our office when a lung biopsy comes back positive and the patient comes in to discuss the results and treatment options.

    Lisi

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