# newly Diagnosis of Breast CA



## dmcbass (Mar 23, 2010)

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?


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## mitchellde (Mar 23, 2010)

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.


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## lisigirl (Mar 23, 2010)

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


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## mitchellde (Mar 23, 2010)

lisigirl said:


> 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


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## lisigirl (Mar 23, 2010)

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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