EM Coding Alert

Question: When can we bill a visit after a surgery for cancer? My colleague says that we can bill the “where we go from here” initial chemotherapy plan during the post-op period. But I’m not sure. Can we bill subsequent office visits when the physician is only clearing the patient to receive chemotherapy? If so, what diagnosis should we use? Or are these visits included in the global?

Maine Subscriber

Answer: You are correct. You may code for the visit(s) during the post-op period that are directly related to chemotherapy or preparation of the patient for chemotherapy. Remember to add modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to each of these visits.

Caution: When you select the level of evaluation and management (E/M) visit (since the patient is in the post-op period), you should not use anything the physician does to or for the patient that is related to recovery from the surgery.

Obviously, you can only use Z51.11 (Encounter for antineoplastic chemotherapy) when the encounter is to administer chemotherapy. But an option for the counseling visit is Z71.89 (Other specified counseling).

If your physician does clearance prior to the administration of chemo, the best code will be Z01.818 (Encounter for other preprocedural examination) or perhaps Z01.89 (Encounter for other specified special examinations).