Oncology & Hematology Coding Alert

Question: A gynecologic oncologist who also performs chemotherapy administration sees a patient during the postoperative period and performs an E/M visit. Should I append modifier -24 to the appropriate established patient visit (99211-99215)?

Arizona Subscriber

Answer: You should use modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) when your oncologist needs to indicate that he performed an E/M service during a postoperative period for reasons unrelated to the original procedure.

For example, a patient has a total hysterectomy (58210, Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with or without removal of tube[s], with or without removal of ovary[s]) after your physician diagnosed the patient with ovarian cancer (183.0). During the postoperative global period, your physician evaluates the patient in the office to determine and discuss the chemotherapy regimen. You should bill 99212 with modifier -24 and report 183.0.

In this case, appending modifier -24 to an E/M service indicates that your oncologist performed the chemotherapy service during the postoperative period, which fits the definition as a "reason unrelated to the original procedure."

Frequently, gynecologic oncologists perform the primary surgical procedure to diagnose, stage and treat the cancer. They also prescribe a chemotherapy regimen and provide medical follow-up. If, however, your oncologist has planned chemotherapy as part of the patient's overall treatment regimen prior to the surgery, you should not separately bill the office visit.