General Surgery Coding Alert

Question: There are six surgeons in our practice, all billing under the same tax identification number. One of the surgeons performed a lumpectomy for a cancer patient. That patient now needs a mastectomy and visits a different surgeon in our practice for a consult. Can we claim the consultation, even though the patient is within the lumpectomy's global period? And after the second surgeon performs the mastectomy, will we need a modifier? Again, the patient is within the global period, but a different surgeon performs the second procedure.

New Jersey Subscriber

Answer: If all the physicians in your practice bill under the same tax identification number, they are (from a billing perspective) the same doctor. And although you can report a consultation for your own patient, you cannot do so during a related procedure's global period. Any related E/M services during the global period are always included in the global surgical fee for the initial, primary procedure.

You may separately report the follow-up excision (the mastectomy) during the global period of the initial excision (the lumpectomy). Select the appropriate CPT code (for instance, 19303, Mastectomy, simple, complete) and append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period). In this case, the surgeon must excise additional tissue to eliminate all malignancy, and this qualifies as a staged or related procedure.

Remember: Even if two different surgeons perform the initial lumpectomy and the follow-up mastectomy, they are billing under the same tax ID number, and you should report the follow-up service as if the two surgeons were the same person.