EM Coding Alert

Question: I have two questions regarding follow-up appointments for the prostate patients we see in our radiation oncology practice.

When the patient finishes their radiation treatment, our doctor orders prostate-specific antigen tests (PSAs) at six weeks, six months, and 12 months following treatment. We send our patients to an outside lab to have the PSA drawn and do not bill for it.

My first question is this: Can we bill an office evaluation and management (E/M) visit when the patient follows up for their PSA results unless the visit falls in the global period for Medicare plans?

Also, patients come in for a consult for radiation therapy. The doctor orders outside imaging, then the patient will follow-up after their imaging to go over the results. Would the follow-up visit be included in the consult and not be billable for an additional follow-up charge?

AAPC Forum Participant

Answer: Radiation oncology bills minimal E/Ms compared to other specialties because the evaluation and management of a condition is mostly bundled into the treatment management codes. However, the types of pre-and post-treatment (after 90 days) visits you mention, especially the six-month and one-year visits, are generally pretty typical and can be billed as E/Ms.

You likely wouldn’t bill the six-week visit because the payer will most likely bundle that E/M as follow-up treatment management. Per CPT^® guidelines for the 77427-77499 (Radiation treatment management) codes, for example, “radiation treatment management requires and includes a minimum of one examination of the patient by the physician for medical evaluation and management (eg, assessment of the patient’s response to treatment, coordination of care and treatment, review of imaging and/or lab test results.” But for subsequent follow-up visits, a separately billed E/M is certainly permissible.