Oncology & Hematology Coding Alert

Question: Our oncologist recently took over the postoperative care of another surgeon's replacement of a peripherally inserted central venous catheter. Should we report E/M codes for these visits, or the surgical code with modifier -52 appended?

New York Subscriber
 
Answer: If your oncologist assumes a patient's postoperative care from a physician in a separate practice, you should report the code for the surgical procedure and append modifier -55 (Postoperative management only). 

The physician who performed the PICC replacement should bill the same procedure code (36584, Replacement, complete, of a peripherally inserted central venous catheter [PICC], without subcutaneous port or pump, through same venous access) with modifier -54 (Surgical care only) appended to indicate that another physician performed the postoperative care.

Medicare's Physician Fee Schedule Database divides the percentage of relative value units into a procedure's pre-, intra- and postoperative components. Appending modifier -52 (Reduced services) to the surgical procedure tells the carrier that you performed the procedure and that the service was reduced, so this modifier isn't appropriate in your scenario.

You should report an E/M code (99231-99233 for inpatients, 99211-99215 for outpatients) only in the rare case that the oncologist treats another problem unrelated to the original surgery. In this case, you would append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code.

If you assume postoperative care from a physician within your practice, you don't have to append any modifiers. You would report the IVC filter placement using your practice's identification number, and the payer would include the other physician's postoperative care in the reimbursement.