Oncology & Hematology Coding Alert
Dont Overlook Modifier -25
Question: During a scheduled bone marrow biopsy, our oncologist typically performs a patient exam, and he knows that is bundled with and supports the biopsy procedure. However, what if the oncologist discovers an unrelated problem? Can he bill for a separate E/M encounter? Minnesota Subscriber Answer: Yes, a new complication or problem may require another E/M encounter above and beyond what is required by the biopsy. However, it is key to remember that if the scenario is flip-flopped, that is, the physician decides to do a biopsy during the course of a regular E/M visit, then you should use modifier -57 (Decision for surgery) instead of modifier -25.
For example, during the office visit, the patient may report nausea with vomiting unrelated to the biopsy (787.01), which may require a GI workup in addition to what you would do for a bone marrow biopsy. In this case, don't forget to make good use of modifier -25 (Significant, separately identifiable E/M service ...) when another patient-care issue arises during the scheduled biopsy.
Oncology & Hematology Coding Alert
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