# gyn oncology-billing for e/ms w/in postop period



## sharlowm (Mar 24, 2014)

I have a gyn oncologist/surgeon who feels that it is appropriate to bill an E/M within the global period of a gyn surgery related to cancer...she tries to take it as a time based level, documents total time spent, that more than 50% was spent counseling and that she discussed pathology, prognosis, future treatment etc. 
I was operating under the belief that this still falls under the global for the surgery and is non-billable since it relates to the same dg as the surgery, ie gyn cancer, as well as the fact that you would expect the post op visit to include some of that discussion anyway..
Am I missing something? Aside from the published rules for what's included in the global period, does anyone have anything in writing about this that may clarify? 
thanks!


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## OCD_coder (Mar 24, 2014)

Understanding what is included in the global period of the surgery is key.  Also, carrier's will have indications as to what they want.  WPS rules allow for managing chemotherapy, this is not part of the global period as defined by the Global Surgery Fact Sheet by CMS.  It's not routine postop care and it's not a complication, it related to the surgery in that the diagnosis is the same - but think of it as furthering the treatment to resolve the patient cancer.  You have to think a little outside of the box to understand possible billable scenarios.


*Appropriate Usage*
Append modifier 24 to the E/M procedure code. 
Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician* during the 10 or 90 day post-operative period. 

Use modifier 24 on the E/M if documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care. 

Use modifier 24 on the E/M code when the same physician* is managing immunosuppressant therapy during the post-operative period of a transplant.

*Use modifier 24 on the E/M code when the same physician* is managing chemotherapy during the post-operative period of a procedure. *

When the same physician* provides unrelated critical care during the post-operative period. 
http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-24.shtml


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