Oncology & Hematology Coding Alert

Question: Does the 90-day global period apply when a self-referred patient continues follow-up with a radiation oncologist who didn't deliver her radiation therapy? The physician is in a different physician group than the physician who delivered the treatment, but the record doesn't explain why she changed physicians. The patient is two months out from her treatment.

Idaho Subscriber

Answer: As long as your documentation supports medical necessity for the follow-up E/M codes you report, you should be OK.
 
Payers typically include the follow-up in the fee for the treatment, but your physician did not provide and was not paid for the treatment. He therefore deserves payment for the services he does provide.
 
Caution: Your physician should clearly document the reason for the change in the patient's medical record. For example, a change in geographic locations would explain the need for a new physician.
 
Let the physician know that documenting the reason for the change is important for two reasons:
 
1. You want to be able to show the payer that the switch isn't an attempt to bypass the 90-day inclusion.
 
2. Your physician could inherit liability if he performs follow-up on a patient he didn't treat, so he should get all the facts and document the case as completely as possible.