Medicare Compliance & Reimbursement

Reader Questions:

Disease Counseling May Qualify You for Post-Op Pay

Question: We had a breast biopsy patient with a breast cancer diagnosis who had an office visit during the post-op period to discuss treatment options (not for surgical follow up). Can I bill for this office visit during the global period, and what diagnosis code should I use to indicate that the service was unrelated to surgery? Answer: Yes, you can separately bill an office visit for treatment counseling during the post-op period. You should code the underlying diagnosis -- 174.x (Malignant neoplasm of female breast). The global package does not include treatment directed at the underlying disease process, even for the most conservative payers like Medicare. The Claims Processing Manual (Internet only manual 100-04) section 40.1B lists "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" as a service not included in the global surgical package. Counseling on treatment [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All